Board Meeting Minutes October 26, 2016 1

1

2 ALABAMA STATE BOARD OF PHARMACY

3

4

5

6

7

8

9 BOARD MEETING

10

11 Wednesday, October 26, 2016

12

13 9:10 a.m.

14

15

16

17

18

19 LOCATION: Alabama State Board of Pharmacy

20 111 Village Street

21 Hoover, Alabama 35242

22

23 REPORTER: Sheri G. Connelly, RPR

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 2

1 INDEX

2

3 ITEM: PAGE NUMBER:

4 Establishment of quorum 6

5 Motion to approve agenda by D. Darby,

6 second by R. Sorrell 6

7 Introductions 6

8 Wellness Report - Dr. Mike Garver 9

9 Presentations:

10 Turenne PharMedCo by L. Foreman 12

11 Motion to use automated dispensing

12 system by D. Darby, second

13 by D. Yeatman 27

14 Affinity MTM by L. Dickinson/M. Maly 29

15 Motion to approve pharmacy services

16 permit by D. Darby, second

17 by D. Yeatman 36

18 Publix Supermarkets by M. King 37

19 Motion to approve remote work

20 processing by D. Darby, second

21 by D. Yeatman 46

22 Treasurer's Report 47

23 Motion to approve report by

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 3

1 R. Sorrell, second by

2 D. Yeatman 49

3 Approval of Minutes:

4 9/21/2016 meeting minutes-Motion by

5 D. Darby, seconded by D. Yeatman 50

6 9/21/2016 interview minutes-Motion by

7 D. Darby, seconded by D. Yeatman 50

8 Inspector's Report 51

9 Secretary's Report 52

10 New business:

11 Motion to approve 2016-2017 budget

12 by D. Darby, second by

13 D. Yeatman 70

14 Request for information re: Executive

15 Secretary evaluation 71

16 Motion for executive session by D. Darby,

17 seconded by D. Yeatman 73

18 Motion for D. Yeatman to negotiate

19 settlement of lawsuit with Virginia

20 College by R. Sorrell, second

21 by B. Bunch 75

22 Motion to adjourn 75

23

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 4

1 ATTENDEES

2

3 BOARD MEMBERS:

4 Buddy Bunch, Vice President

5 David Darby, Treasurer

6 Donna Yeatman, Member

7 Ralph E. Sorrell, Member

8

9 ALSO PRESENT:

10 Susan Alverson, Ph.D., Executive Secretary

11 Cristal Anderson, Director of Compliance

12 Eddie Braden, Chief Inspector

13 Todd Brooks, Drug Inspector

14 Glenn Wells, Drug Inspector

15 Scott Daniel, Drug Inspector

16 Mark Hebert, Drug Inspector

17 Peyton Zarzour, Drug Inspector

18 Terry Lawrence, Board of Pharmacy

19 Rhonda Coker, Board of Pharmacy

20 Mike Garver

21 Jeff Freese

22 Sarah Barker

23 Laurie Dickinson

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 5

1 Michelle Maly

2 Nancy Bishop

3 Charlie Cook

4 Kevin Ryan

5 Mike King

6 Chris Burgess

7 Cammie Burgess

8 Katie Jones

9 Louise Jones

10 Tracy Davis

11 Eddie Vanderver

12 Rod Harbin

13 Jon Linna

14

15 ********************************

16

17 MR. BUNCH: This is the October

18 meeting of the Alabama State Board of Pharmacy.

19 I'm Buddy Bunch, Vice President. Our president

20 is not here today but if you'll bear with me,

21 we'll try to get through this thing. Y'all are

22 probably going to have to help me with it, but

23 welcome.

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1 We have a quorum here of board members

2 and I guess we need to have a motion made to

3 adopt the agenda.

4 MR. DARBY: I make a motion we adopt

5 the agenda as presented in the Dropbox.

6 MR. SORRELL: I second it.

7 MR. BUNCH: I've got a motion and a

8 second. All in favor?

9 MS. YEATMAN: Aye.

10 MR. SORRELL: Aye.

11 MR. DARBY: Aye.

12 MR. BUNCH: Any opposed?

13 (No response.)

14 MR. BUNCH: Hearing none, the agenda

15 is adopted.

16 We'll need to have everybody if you

17 will just stand up, introduce yourself, give

18 Sheri your name so we can get that on the record

19 and we'll start with Terry.

20 MR. LAWRENCE: Terry Lawrence, State

21 Board of Pharmacy.

22 MS. COKER: Rhonda Coker, Board of

23 Pharmacy.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 7

1 MR. FOREMAN: Lee Foreman, Turenne

2 PharMedCo.

3 DR. GARVER: Mike Garver, the Board's

4 Wellness committee.

5 MR. FREESE: Jeff Freese, Turenne

6 PharMedCo.

7 MS. BARKER: Sarah Barker, Turenne

8 PharMedCo.

9 MS. DICKINSON: Laurie Dickinson,

10 Affinity MTM.

11 MS. MALY: Michelle Maly, Affinity

12 MTM.

13 MS. BISHOP: Nancy Bishop, Alabama

14 Department of Public Health.

15 MR. COOK: Charlie Cook, ALSHP.

16 MR. RYAN: Kevin Ryan, CardinalHealth

17 NPS.

18 MR. KING: Mike King, Publix

19 Supermarkets.

20 MR. BURGESS: Chris Burgess, Heritage

21 Pharmacy.

22 MS. BURGESS: Cammie Burgess, UAB

23 Hospital.

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1 MS. JONES: Katie Jones, Alabama

2 Pharmacy Association.

3 MS. JONES: Louise Jones, Alabama

4 Pharmacy Association.

5 MS. DAVIS: Tracy Davis, Hand Arendall

6 for APA.

7 MR. VANDERVER: Eddie Vanderver, CAPS,

8 Incorporated.

9 MR. HARBIN: Rod Harbin, Wellness

10 Pharmacy.

11 MR. LINNA: Jon Linna, Senior Care

12 Pharmacy.

13 MR. DANIEL: Scott Daniel, Alabama

14 State Board of Pharmacy.

15 MR. WELLS: Glenn Wells, Alabama State

16 Board of Pharmacy.

17 MR. HEBERT: Mark Hebert, Alabama

18 Board of Pharmacy.

19 MR. BROOKS: Todd Brooks, Board of

20 Pharmacy.

21 MR. BUNCH: All right. Thank you very

22 much. We'll start on the agenda and we'll take

23 one a little bit out of order. We've got

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 9

1 Dr. Mike Garver here with the Wellness report

2 and if you'd like to go ahead and do that, Mike.

3 DR. GARVER: Good morning. Thank you

4 for letting me be here. It's good to see all of

5 you this week.

6 Here is the report for the last part

7 of September through October to this point.

8 There are presently 154 people in our screening

9 program with signed contracts and orders. This

10 number includes any individuals on a diagnostic

11 monitoring contract but does not include any of

12 the individuals that are listed below in the

13 current work.

14 There are three pharmacists in

15 inpatient treatment. There are three pharmacy

16 technicians in treatment. There are two

17 pharmacy technicians who are in the process of

18 going for an evaluation. There is one student

19 in maintenance phase of treatment, that is an

20 outpatient treatment after inpatient, and that

21 treatment is ongoing to this point. There's one

22 student who has had all their treatment and is

23 self-reporting as a freshman student and we're

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 10

1 dealing with that student with the pharmacy

2 staff right now and we have two new students who

3 are going for evaluation, so we've identified a

4 lot of students this year.

5 The total number of pharmacy

6 professionals identified and worked with in 2016

7 to this point is 37. There are 18 pharmacists,

8 15 pharmacy techs, and four students. The total

9 number of pharmacy health professionals

10 identified in this time period in 2015 is 29, so

11 that's up a little bit and it's hard to tell

12 whether the number goes up or down from year to

13 year very much, but 33 is a lot and I credit

14 that to staff work, the inspectors, and all the

15 people who have helped the pharmacists who are

16 out in the field identifying their coworkers and

17 asking them to get help. It's a really nice

18 thing to see.

19 All of the individuals who are in

20 treatment or in evaluation or undecided are

21 presently out of the workplace and without

22 license and that usually means with a voluntary

23 suspension of some sort. There are five others

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 11

1 who are working their way through halfway house,

2 Time Out for Recovery up to six months or those

3 who are in the process of being investigation or

4 scheduled for hearings and includes those who

5 cannot make up their minds, and we do have one

6 or to have those every month, and there are 77

7 individuals in facility-driven aftercare. That

8 aftercare is any -- any type of institutional

9 meeting that a person signs up to go to or is

10 instructed to go to after their treatment, so

11 that's the formal part of the report and I would

12 ask the Board if there are any questions that I

13 could answer.

14 (No response.)

15 DR. GARVER: No? All right. It's

16 good to see you all. I'll see you in January

17 with the December report and the final

18 statistics for the year 2016. Thank you

19 again.

20 MR. DARBY: Thank you.

21 MS. YEATMAN: Thank you.

22 MR. WARD: Be careful, Dr. Garver.

23 MR. BUNCH: Yeah, thank you,

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 12

1 Dr. Garver.

2 DR. GARVER: Appreciate it.

3 MR. BUNCH: All right. I guess we'll

4 move on to the presentations that we have today.

5 It looks like we have three just going down

6 beginning with number one on the list is Turenne

7 PharMedCo. If you guys want to have a seat

8 there.

9 MR. FOREMAN: Good morning, Ladies and

10 Gentlemen of the Board. I really appreciate

11 you allowing me to be here today. My name is

12 Lee Foreman and I am the general manager for

13 Turenne PharMedCo in Montgomery, Alabama, and I

14 wanted to talk to you guys about automated

15 dispensing use in long-term care facilities,

16 specifically around the system that we are

17 trying to use, Cubex.

18 So first I want to tell you a little

19 bit about Turenne. We are a closed-door

20 independent pharmacy located in Montgomery,

21 Alabama. We currently service long-term care

22 facilities and assisted livings, mental health

23 homes, and group homes across the entire state.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 13

1 We are located -- our home branch in Montgomery

2 with a satellite branch here in Birmingham and

3 currently service our customers with blister

4 cards as well as multidose strip packaging

5 units.

6 So why am I here today? I'm here to

7 ask the Board's approval for utilization of the

8 newly approved 680-X-2-.18 Institutional

9 Pharmacy, specifically number (6), which is

10 automated dispensing systems in skilled nursing

11 facilities.

12 So Turenne PharMedCo currently

13 services 21 skilled nursing facilities across

14 the entire state. Each one of those is complete

15 with a emergency medication kit or you guys may

16 also know it as a stat box and we also provide

17 six-day-per-week delivery to most of our

18 facilities and provide 24-hour on-call services

19 to all of our facilities.

20 So part of the on-call services, you

21 know, it is operated by a pharmacist and

22 includes servicing the residents and the

23 facilities with that emergency medication kit as

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 14

1 well as the use of backup pharmacies across the

2 entire state. Utilization and management of the

3 emergency medication kit can be very cumbersome,

4 not only for the facility but also for the

5 pharmacy and it specifically surrounds things

6 like utilization, the reconciliation process,

7 reporting, and then also billing to not only the

8 residents as well as to the facility.

9 So Turenne's solution to help us with

10 this, not to correct everything but to help, is

11 Cubex, which is a automated dispensing system

12 and is of the Pyxis family. So to tell you a

13 little bit about Cubex. It is composed of three

14 different pieces of technology. First off is

15 the CRX station, which is located inside the

16 pharmacy, which is going to be utilized by the

17 pharmacy technicians as well as the pharmacist.

18 You have what's called a med bank, which is

19 located inside the facility. All of ours will

20 be located in the med rooms of the facilities

21 and then also a My Q Link Cloud, which is going

22 to be a web-based management database, which is

23 going to help us with the communication from the

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 15

1 CRX station located in the pharmacy, the med

2 bank located inside the facility, and then help

3 that communication back and forth to our

4 pharmacy operating system.

5 So this is a 50-foot view of the

6 overall process, so I just want to walk through

7 this very -- very quickly with you. We're going

8 to start right here with the CRX station. This

9 is located inside the pharmacy, so what we will

10 be doing is upon the -- if we get the Board's

11 approval today would be to package medication in

12 a unit of use packaging complete with the drug

13 name, dosage, NDC number, expiration date, and

14 lot number. So its pharmacy technicians will

15 utilize this machine to package these

16 medications and place them into what we call a

17 cube.

18 This cube is located right here. It

19 is tamper evident, not tamper resistant, so they

20 will package the medications into these cubes

21 and then it will be checked by a pharmacist.

22 Now, the special thing about this cube is that

23 each time or each one of these is comprised of a

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 16

1 microchip, which will house all the information

2 for that medication that I mentioned earlier, so

3 the drug name, dosage, NDC number, lot number,

4 expiration, as well as the facility and the

5 location inside the med bank as to which --

6 where it should go specifically. Therefore, the

7 wrong medication cannot go to the wrong facility

8 and placed in the wrong location allowing it to

9 be misused.

10 It will be delivered to the facility

11 by our delivery drivers and located -- this is

12 another version of the med bank that will be

13 located inside the facility. Again, this will

14 be behind the med room doors and according to

15 ADPH law behind a double lock. Nurses will then

16 access the med bank to utilize medication and be

17 able to pull it for specific residents. That

18 information when a nurse logs in is going to

19 then be transmitted to My Q Link, the Cloud, and

20 that is going to then come to our pharmacy

21 dispensing system, which is QS1.

22 You'll also note that EMR and billing

23 systems are also available; however, we are not

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 17

1 going to have the capabilities of utilizing

2 those for our facilities just yet due to

3 technology restraints, so -- but that is -- I

4 just want to put it up there for future

5 reference. So again, that's the 50-foot view as

6 to what the overall process looks like.

7 This is just another view of the

8 Cubex. This is again the med bank mini and you

9 can notice right here this is what the drawers

10 will look like. I'm sure all of you have seen

11 something similar with the Pyxis machines and

12 the unit of use packaging inside each. So the

13 nurse goes up to the med bank, she registers

14 herself. We will -- she will pick the resident

15 that she's pulling the medication for. She will

16 pick the medication that she's using it for,

17 pull the quantity that she needs. Another thing

18 that we really like about the Cubex system is

19 it's going to require blind countbacks for

20 medication as well as the ability for it not to

21 be utilized before there is an actual order for

22 the medication.

23 So this is just another view of the

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 18

1 drawer. We have three different sizes of cubies

2 that you can see to -- based off what medication

3 would go into that -- those cubes. So the

4 contents of the Cubex will be controlled and

5 noncontrolled medication that will be determined

6 by the pharmacist in charge for Montgomery,

7 which is myself, the medical director of the

8 facility, the administrator of the facility, as

9 well as the director of nursing. Each med bank

10 is separated into drawers and so we will have

11 all controlled medications in one drawer and

12 then noncontrolled medications in the other

13 drawers.

14 So things that we hope to accomplish

15 with this utilization of technology is first off

16 going to be increased security for the emergency

17 medication kit, decrease in diversion, which,

18 you know, is a big deal for all of us that's

19 within the pharmacy profession and so we think

20 that if -- you know, if we're having better

21 accountability in those emergency kits, then

22 it's definitely going to help decrease that

23 diversion, especially with the things like the

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 19

1 blind countback and the enhanced reporting and

2 the discrepancies and what not.

3 We're also going to have the enhanced

4 accountability, so making sure that the right

5 patient gets the right medication. Again, we

6 don't have a nurse just going into a tackle box

7 inside a med room and picking a medication based

8 off a drug order. You're actually having to put

9 in that resident's name, picking that

10 medication, and it's going to ask you on several

11 different occasions is this correct.

12 The nurse we'll also have, again for

13 the diversion and the accountability, we have a

14 reconciliation of the nurse as well as the

15 medication that's being utilized. This is going

16 to help us with billing, so lead to decreased

17 drug costs not only for the residents but also

18 for the facilities. Decreased administration

19 errors, again, the nurse going in, picking the

20 right resident, the right drug, and being asked

21 on multiple occasions is this correct.

22 Better inventory control of our

23 emergency kits to make sure that we're able

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 20

1 to -- or have the right medication in the

2 facility that they may need, so we can look at

3 reporting and say, okay, you haven't used this

4 drug so we're going to take it out or you've

5 used a lot of this so we might need to look at

6 increasing the amount in the -- in this box.

7 Easier reconciliation for our monthly

8 consulting visits, so, you know, as the

9 consultant and their team goes into a skilled

10 nursing facility each month to reconcile the

11 e-kits, it's going to be a lot easier process

12 for them and then easier access and visibility

13 into each facility's e-kit to address situations

14 like -- again, to drug utilization either

15 increasing or decreasing our quantities.

16 Expired medications and drug recalls,

17 so right now, you know, if we have a drug recall

18 or if we're having to send out, you know,

19 documentation saying, hey, this -- do you have

20 this or having to go and physically look at it

21 for ourselves. Now we're going to be able to

22 have that information all stored right there to

23 know if that product is out in the field and we

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 21

1 can easily obtain it, and then reporting for

2 discrepancies and errors.

3 So upon approval, if you guys deem it

4 so today, we would like to start this process

5 off at Westside Terrace Health and Rehab First.

6 It is a skilled nursing facility located in

7 Dothan, Alabama, and it will be placed in the

8 Rehab First med room of that facility and we

9 hope that upon your approval today, if you deem

10 so, to put this plan into place in November.

11 So with that, I really appreciate your

12 time and will open up the floor for any

13 questions.

14 MR. BUNCH: Thank you. Any questions

15 from the Board members?

16 MR. SORRELL: I've got one or just

17 curiosity.

18 MR. FOREMAN: Yes, sir.

19 MR. SORRELL: Obviously this is light

20 years ahead and much better than a tackle box.

21 MR. FOREMAN: Yes.

22 MR. SORRELL: But who actually puts

23 the cube in the Cubex?

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1 MR. FOREMAN: So per the new rule, it

2 can either be a registered technician or a

3 skilled nurse and so we will be delivering the

4 medication or the cubes to the facility and the

5 skilled nurse will be placing it into the

6 machine.

7 MR. SORRELL: Who will -- will there

8 be double verification of the tamper -- tell me

9 about your tamper tape or your tamper evident --

10 MR. FOREMAN: Yes, sir.

11 MR. SORRELL: -- so that in my mind,

12 I'm picturing old technology, but there really

13 needs to be two people standing there to verify

14 that it wasn't tampered with as it goes into the

15 system.

16 MR. FOREMAN: Right, yes, sir. So if

17 it is tampered with, then it's in our policy and

18 procedures that the nurse is not to -- or put

19 into the -- it won't go into the machine if the

20 top has been popped or anything like that.

21 MR. SORRELL: Okay, good.

22 MR. FOREMAN: And so we will not allow

23 it to be placed into the machine.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 23

1 MR. SORRELL: Great.

2 MR. FOREMAN: And after -- if it's not

3 placed into the machine within a certain amount

4 of time, a report is generated, sent back to us,

5 and we then are notified that, hey, this has not

6 been placed into the machine, you need to either

7 talk to the director of nursing to find out

8 where it is or send a request to pick it up.

9 MR. SORRELL: Okay.

10 MR. DARBY: I had a couple of

11 questions on the policy and procedures.

12 MR. FOREMAN: Yes, sir.

13 MR. DARBY: You're allowing 72 hours

14 to review a order. Why such a long time?

15 MR. FOREMAN: Strictly because mostly

16 of weekends, you know, and that's definitely

17 something that we can review and make it a lot

18 shorter, but really just to help our nursing

19 facilities and the staff for a weekend

20 process.

21 MR. DARBY: And then I noticed that

22 there's a discrepancy with the controlled drugs.

23 You've got in there that the supervising

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1 pharmacist will be in charge of notifying the

2 DEA within seven days.

3 MR. FOREMAN: Yes, sir.

4 MR. DARBY: I would like to see you

5 add that you would notify the State Board of

6 Pharmacy within seven days also.

7 MR. FOREMAN: Yes, sir, yes, sir.

8 Okay.

9 MS. YEATMAN: My question is why seven

10 days.

11 MR. FOREMAN: That was part of the --

12 I put that in there because I believe it was

13 part of the DEA --

14 MS. YEATMAN: They give you seven

15 days?

16 MR. FOREMAN: Seven days notification

17 of controlled.

18 MR. DARBY: Well, 106 you only have --

19 I know by my experience with break-ins, you only

20 have -- it's like 24 hours, isn't it?

21 MS. YEATMAN: Yeah.

22 MR. FOREMAN: Okay. I can

23 definitely --

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 25

1 MS. YEATMAN: Do an initial

2 notification within 24 hours.

3 MR. BRADEN: Twenty-four hours is

4 correct.

5 MR. FOREMAN: I can definitely reset

6 it. No problem.

7 MS. YEATMAN: So just keep you in line

8 as you make that adjustment.

9 MR. FOREMAN: Sure, okay.

10 MR. BUNCH: Anything else?

11 MR. WARD: Who inventories?

12 MR. FOREMAN: On a monthly basis or --

13 MR. WARD: Just whenever.

14 MR. FOREMAN: So the original

15 inventory will be determined by the pharmacist

16 in charge, myself, the medical director, D.O.N.

17 and the administrator, and then each month the

18 QAs and our consultant pharmacist will go into

19 the facilities and do an inventory each month.

20 MR. WARD: I'm talking about the

21 machines, how do you -- like how many particular

22 pills will it hold?

23 MR. FOREMAN: It depends on the drug

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 26

1 that we're talking about and the different size

2 of the cubes.

3 MR. WARD: Who decides when these

4 people are going to load it back up again?

5 MR. FOREMAN: So it's going to be --

6 let's say that I decide to put, I don't know,

7 five Norco 5 in one of the cubes. I can set

8 maximum and minimum quantities and so if a

9 facility gets to a minimum quantity, what it's

10 going to do is it's going to send me an alert

11 and says, hey, this facility is at five or at

12 two and it's going to say, hey, you need to

13 replenish that.

14 MR. WARD: And if somebody brings out

15 the drugs, how do you fill it back up?

16 MR. FOREMAN: So it's going to

17 generate a report and send it to me and then the

18 next day, I'm going to fill another cube with

19 that medication. I'm going to send it to the

20 facility. It's going to replace and that cube

21 is going to come back to me, even if it still

22 has two in it or not.

23 MR. WARD: And the nurses will be

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 27

1 doing it?

2 MR. FOREMAN: Yes, sir.

3 MR. WARD: All right. Thank you.

4 MR. DARBY: I like the blind count in

5 there --

6 MR. FOREMAN: Yes, sir.

7 MR. DARBY: -- where they don't know

8 how many are there.

9 MR. FOREMAN: Right, yes, sir.

10 MR. BUNCH: Anything else? I guess

11 with those additions and clarifications that the

12 board members made --

13 MR. FOREMAN: Yes, sir.

14 MR. BUNCH: -- with those in mind, I

15 guess we'll entertain a motion to approve the

16 cube, I guess.

17 MR. FOREMAN: Cubex.

18 MR. BUNCH: Cubex. Do I have a

19 motion?

20 MR. DARBY: I'll make a motion that we

21 allow Turenne PharMedCo to -- that's a --

22 MR. FOREMAN: It is a mouthful.

23 MR. DARBY: Turenne PharMedCo to use

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 28

1 automated dispensing system at Westside Terrace

2 Health and Rehab First in Dothan, Alabama,

3 effective November 1.

4 MS. YEATMAN: Second.

5 MR. BUNCH: I have a motion and a

6 second. All in favor?

7 MS. YEATMAN: Aye.

8 MR. SORRELL: Aye.

9 MR. DARBY: Aye.

10 MR. BUNCH: Aye.

11 Any opposed?

12 (No response.)

13 MR. BUNCH: Hearing none, the motion

14 carries, so you're good.

15 MR. FOREMAN: Thank you. I appreciate

16 it. Thank you.

17 MS. YEATMAN: Would you send us an

18 updated policy and procedure with those changes?

19 MR. FOREMAN: Yes, ma'am, will do,

20 yes, ma'am. Thank you.

21 MR. DARBY: Thank y'all.

22 MR. BUNCH: Appreciate it. All right.

23 Number two is the Affinity MTM ladies.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 29

1 MS. DICKINSON: Good morning. Thank

2 you so much for having us today. My name is

3 Laurie Dickinson. This is Michelle Maly. We

4 are pharmacists. Our company is Affinity MTM.

5 We are here today seeking a pharmacy services

6 permit to become a consulting pharmacy service

7 that provides community-based MTM.

8 Just to tell you a little bit of

9 background. The Affordable Care Act created the

10 CMS five-star rating system, which measures

11 Medicare beneficiaries' experience with their

12 health care system. The CMS 2016 star ratings

13 added a new measure called the medication

14 therapy management program completion rate for a

15 comprehensive medication review. Just to help

16 define what MTM program is, it is defined as a

17 program of drug therapy management that may be

18 furnished by a pharmacist and designed to assure

19 with respect to targeted beneficiaries that

20 covered drugs under the prescription drug plan

21 are appropriately used to optimize therapeutic

22 outcomes through improved medication use and to

23 reduce the risk of adversities, including

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 30

1 adverse drug reactions.

2 Affinity MTM is a service-based

3 pharmacy or will be a service-based pharmacy

4 pending approval. Our role will be to provide

5 medication therapeutic interventions to improve

6 patient outcomes and reduce health care costs.

7 Our main goals are to empower patients, provide

8 follow-up communication, to evaluate patients'

9 therapy, and statistical reports needed by

10 physicians and regional care organizations. We

11 hope to provide a bridge between patients and

12 health care providers to improve medication

13 adherence and therapeutic outcomes.

14 So that being said, were there any

15 questions or things you'd like to ask us as far

16 as the --

17 MR. BUNCH: Any questions from the

18 Board members?

19 MR. SORRELL: Are you aligned with a

20 particular pharmacy or do you plan to contract

21 with any number of pharmacies?

22 MS. MALY: We'll be independent.

23 We're planning on -- we've talked to Outcomes

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 31

1 and Mirixa and then we've talked to several

2 physicians that are interested in us providing

3 those services for their patients.

4 MR. SORRELL: How do you communicate

5 with the patients' pharmacy -- pharmacists?

6 MS. MALY: This will be with the

7 patients and their physicians. We can always

8 communicate with their pharmacies as need be.

9 MR. DARBY: So your address is on

10 Riverchase Parkway. You'll be doing this from

11 that location?

12 MS. MALY: Yes, sir, it will be face

13 to face. There may be times where it's

14 telephone.

15 MR. WARD: Do you have pharmacy

16 records there?

17 MS. MALY: Yes, sir.

18 MS. DICKINSON: Yes, sir.

19 MR. SORRELL: How do you get the

20 pharmacy records if you're dealing with the

21 physician and the patient? How do you -- how do

22 you have the patient's pharmacy records?

23 MS. DICKINSON: We will have an

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 32

1 integration as far as computer program that

2 would send electronic medical records to us

3 which will be fully HIPAA compliant. As far as

4 IT, we would make sure everything is within

5 regulations and as far as that goes when they

6 are sent to us.

7 MR. SORRELL: But if you've got a

8 patient using multiple physicians and multiple

9 pharmacies, I'm just trying to get my head

10 around how you get all the data that you need to

11 do an MTM.

12 MS. MALY: Well, when we first --

13 we'll interview the patients. We'll get

14 documentation from the patients of what they

15 have and then we will verify that with their

16 physicians.

17 MR. SORRELL: Okay, got you.

18 MR. WARD: Are you going to have

19 actual pharmacy records or just records of the

20 physician that says what drug they're getting?

21 MS. MALY: It will just be that. It

22 will just be, you know, the information that we

23 take from the patient and then the information

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 33

1 we take from the physicians. There will be no

2 prescription, per se.

3 MR. WARD: How will you know if

4 they're compliant if you don't know what's

5 filled or what they're supposed to take?

6 MS. MALY: That will be from the

7 communication with the patient.

8 MR. WARD: Do you trust them?

9 MS. MALY: Well.

10 MS. DICKINSON: We'll also have -- for

11 each -- there will be about four disease states

12 that we will concentrate on and there will be

13 different measures that we use -- statistics and

14 measures that we would keep up with to determine

15 compliance, you know, interviewing with a

16 patient, communicating with a doctor as well.

17 MR. WARD: Who bills for this, y'all

18 or the doctor?

19 MS. MALY: We will.

20 MR. WARD: You do.

21 MR. BUNCH: So y'all get an MTM case

22 like from -- like in my pharmacy I get an MTM

23 case from -- pops up, we work it and do it, so

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 34

1 it would come to you guys instead of going to a

2 pharmacy?

3 MS. DICKINSON: Correct, through

4 Outcomes or Mirixa, yes, sir.

5 MR. BUNCH: So how do -- I guess how

6 do they know to send it to you and not to send

7 it to -- how do they know to send it to you and

8 not to a pharmacy that the patient is going to?

9 MS. MALY: Okay. Well, there's a lot

10 of pharmacies that right now are so busy that --

11 where they do not provide the MTM services.

12 MR. BUNCH: Right.

13 MS. MALY: And that's where we are

14 wanting to pick up with Mirixa and Outcomes that

15 they can -- those patients --

16 MR. BUNCH: So ABC Pharmacy is not

17 working their MTM cases --

18 MS. MALY: Right.

19 MR. BUNCH: -- then they get sent to

20 you guys?

21 MS. DICKINSON: Uh-huh.

22 MR. WARD: I'm probably the only one

23 in the room that doesn't know, what is Mirixa

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 35

1 and Outcomes? Are those companies?

2 MR. DARBY: Yeah, they're platforms

3 that send you MTM cases. I guess they contract

4 with the insurance companies --

5 MS. DICKINSON: Insurance companies,

6 correct.

7 MR. DARBY: -- to handle them.

8 MS. DICKINSON: Correct.

9 MR. WARD: Okay. Are you going to

10 have any technicians?

11 MS. MALY: Not at this time. If we

12 do, there would be stipulations on what they

13 could and could not do, you know. They can take

14 demographics to then be verified by the

15 pharmacist, set up appointment times, filing,

16 that kind of thing.

17 MR. SORRELL: And if this is approved,

18 you know that we would expect your technicians

19 to comply with the ratios of this state.

20 MS. MALY: Exactly.

21 MR. BUNCH: Anything further from the

22 Board members?

23 (No response.)

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 36

1 MR. BUNCH: We'll entertain a motion

2 to approve Affinity MTM to perform MTM services

3 from their location in Birmingham -- yeah, in

4 Birmingham.

5 MR. DARBY: I make a motion we approve

6 a pharmacy services permit for Affinity MTM.

7 MS. YEATMAN: Second.

8 MR. BUNCH: A motion and a second.

9 All in favor?

10 MS. YEATMAN: Aye.

11 MR. DARBY: Aye.

12 MR. BUNCH: Aye.

13 Any opposed?

14 (No response.)

15 MR. BUNCH: Motion carries. Good

16 luck.

17 MS. MALY: Thank you.

18 MS. DICKINSON: Thank you so much.

19 MR. DARBY: Y'all do know -- all

20 right, so you'll get a permit now but you'll

21 have to renew it almost immediately.

22 MS. MALY: Right.

23 MS. DICKINSON: Correct, yes. Thank

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 37

1 you.

2 MR. BUNCH: You may want to wait.

3 MR. DARBY: That's from your

4 treasurer.

5 MR. WARD: And if -- and if patients

6 are like clients, they won't always tell you

7 what they do.

8 MS. MALY: Right.

9 MR. BUNCH: All right. Good deal.

10 Moving right along, next on the agenda is Publix

11 Supermarkets. You guys come up. Go ahead and

12 give us your presentation.

13 MR. KING: Sure. I have a letter that

14 we sent but I don't have a PowerPoint. Do you

15 have that letter? I have copies for you.

16 MR. BUNCH: I have it.

17 MS. YEATMAN: I didn't get a copy. My

18 iPad just died.

19 MR. KING: Good morning. My name is

20 Mike King. I'm with Publix supermarkets. I'm

21 the pharmacy operations manager. I oversee

22 Tennessee, most of Alabama, and most of Georgia.

23 That's my role.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 38

1 I'm here in response to a letter that

2 our company sent that Andy Shaw, who was my

3 supervisor at the time, sent back in May

4 requesting some questions answered about remote

5 processing, work sharing across the pharmacies

6 in Alabama.

7 There were three questions in the

8 letter. The first is that we have added some

9 new stores since the last time we came to the

10 Board, quite a few stores actually, and they're

11 on the back page of this letter, and so we

12 wanted to start engaging those pharmacies in

13 processing and remote processing. We also

14 wanted to shrink our pod size down a little bit

15 with the addition of these new stores. Of

16 course, these stores will be kept in a

17 geographical proximity to each other. That was

18 one question that we had for you.

19 We also wanted to know in the future

20 as we continue to add stores -- we actually have

21 a store coming in December and in January -- do

22 we need to come to you each time we add a store,

23 is that your desire?

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 39

1 And also we're sending you -- the

2 third question we had was that we're sending you

3 quarterly some data on our processing and wanted

4 to know did you still need that data or are we

5 just sending you stuff that you don't need? I'm

6 sure people don't want to get spam if they don't

7 need it, so we just want to know do you still

8 need that information. So those were the

9 questions that we had for you today.

10 MR. WARD: Well, just let me ask you

11 this: In the past we've had a little issue with

12 all of this with y'all. How is this going to

13 be -- the work flow going to be divided?

14 MR. KING: Well, they're divided into

15 pods and so they would work inside these pods in

16 groups. Nothing would change from that

17 perspective.

18 MR. WARD: So all of these are going

19 to be -- how do we know what pods they're going

20 to be in?

21 MR. KING: They're broken down here

22 titled Birmingham-South, Birmingham-Southeast,

23 Birmingham-East, Birmingham-West, so we have --

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 40

1 MR. WARD: So remote processing group

2 really means pod?

3 MR. KING: Processing group, pod,

4 yeah, same thing, yes, sir.

5 MR. SORRELL: What's the maximum

6 number of pharmacies that a pharmacist would be

7 responsible for supervising? How many stores

8 would a pharmacist be responsible for

9 supervising or filling prescriptions for or

10 approving the prescription fill for?

11 MR. KING: The maximum size that we

12 put on here was ten.

13 MR. SORRELL: Oh, my God. Well,

14 excuse me.

15 MR. KING: Well, inside these actual

16 groups, they are much smaller than that. Well,

17 they're sharing across themselves. They're

18 not -- one person is not responsible for all of

19 them. They're just responsible for -- they're

20 all responsible for checking and making sure

21 that everybody is okay and the proposed are

22 smaller than we currently have now.

23 MS. YEATMAN: So you have ten now?

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 41

1 MR. KING: We have some stores that

2 are -- some pods that are close to that level,

3 yes, and so this actually would be --

4 MR. WARD: All right. So just make

5 sure I understand, for Birmingham-Southeast,

6 those are your stores; right?

7 MR. KING: Yes, sir, those five

8 stores.

9 MR. SORRELL: I'm sorry, I missed it.

10 Are you a pharmacist?

11 MR. KING: I am a pharmacist in

12 Georgia and Florida, yes, sir.

13 MS. YEATMAN: How did you -- how did

14 you arrive at these pods because geographically

15 they're a little odd?

16 MR. KING: We tried to put them as

17 close geographically as we could. Our density

18 of stores in this state in some areas is not as

19 large as some maybe of our competitors are but

20 we did try to stick them geographically

21 together. That was the goal.

22 MR. SORRELL: My only concern here is

23 that if you've got a patient in front of you who

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 42

1 needs you to walk out and talk to them about

2 their cough syrup or their blood pressure

3 medicine or their selection of a toothbrush and

4 you've got ten queues to worry about on your

5 screen and you've got somebody sitting in

6 wherever monitoring their productivity, what

7 incentive do they have to go out and help a

8 patient with a clinical question when they've

9 got ten stores to worry about coming into their

10 queue. That -- that just -- I worry about the

11 public health being served from a pharmacist's

12 point of view, not from a product point of view.

13 I'm sure it's extremely efficient production,

14 profit wise, business model wise but these

15 pharmacists need to feel comfortable walking out

16 and talking to a patient.

17 MR. KING: Sure.

18 MR. SORRELL: And I can see doing

19 that -- if you've got a couple of stores down

20 the street and you want to help out your buds

21 when they're real busy and you're not, by all

22 means but ten.

23 MR. KING: Well, that's why in this

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 43

1 proposal it's smaller than what we currently

2 have. We went to a smaller size.

3 MS. YEATMAN: It appears that your

4 size now, the biggest on here is eight if

5 I counted right.

6 MR. KING: Yes, yes, that would be

7 correct.

8 MS. YEATMAN: So the way -- this is

9 just my opinion and I'll let the other board

10 members -- you had four questions that you've

11 put before us. Do you need to come back every

12 time you add additional stores. I would say to

13 that yes --

14 MR. DARBY: Yes.

15 MS. YEATMAN: -- from the standpoint

16 that we need to know how many you're going to

17 have working jointly, so that would be a yes.

18 MR. KING: Okay.

19 MS. YEATMAN: Shrinking the pod sizes,

20 I agree with shrinking them. I think what you

21 have here -- again, the geography is a little

22 odd to me but I understand what you're saying as

23 far as how your stores are spaced out and

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 44

1 actually I think you asked the same thing twice,

2 to add additional stores -- and I have three.

3 Do you have to come every time you add an

4 additional store, so I may have messed up --

5 MR. KING: I may have repeated the

6 question.

7 MS. YEATMAN: So that's a yes.

8 MR. KING: Okay.

9 MS. YEATMAN: And then do you need to

10 still send the quarterly information, that's a

11 yes.

12 MR. KING: Okay.

13 MS. YEATMAN: Did that help you?

14 MR. KING: Yes, ma'am, with the new

15 stores that we've added in the last few years,

16 may we engage them to start practicing?

17 MS. YEATMAN: Are they on this current

18 list?

19 MR. KING: They're on this current

20 list, yes. They're identified there, they say

21 new.

22 MS. YEATMAN: Okay. That's probably

23 where my -- my notes -- that's probably two

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 45

1 separate questions you asked and I wrote them as

2 the same question.

3 MR. WARD: And we know that the pod

4 for southeast Birmingham will not be podding

5 with the one from Huntsville-East.

6 MR. KING: Correct.

7 MR. WARD: It will be -- that's your

8 representation to the Board.

9 MR. KING: Our representation, yes,

10 these pods are -- if you're in a store in

11 southeast, you cannot see Huntsville.

12 MR. WARD: It's set up that way?

13 MR. KING: It's set up that way, yeah.

14 You could see them in terms of if you wanted to

15 go see a patient or look at something but you

16 can't do their work for them.

17 MS. YEATMAN: So when you're asking

18 about the new stores, those are depicted on

19 your -- on your handout, for lack of a better

20 word, as new and you're just saying can those

21 now be part of this program is your question?

22 MR. KING: Yes, ma'am.

23 MS. YEATMAN: I'm -- we will have to

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 46

1 take a motion on it but I think I'm fine with

2 that, again going back to Mr. Ward's point that

3 they stay within that group.

4 MR. KING: Okay.

5 MR. BUNCH: Any other questions or

6 comments?

7 (No response.)

8 MR. BUNCH: Do we need a motion or is

9 this a question and answer?

10 MR. DARBY: Yeah, I think we need a

11 motion on that.

12 MR. BUNCH: All right. Yeah, I guess

13 especially on the last part. Okay. We'll

14 entertain a motion.

15 MR. DARBY: I'll make a motion that we

16 approve the new remote processing groups for

17 Publix Supermarkets in Alabama.

18 MS. YEATMAN: And I'm being requested

19 to add subject to the depiction they have given

20 and their assurance that all of these pods will

21 remain as indicated on your document.

22 MR. DARBY: That will be my amendment.

23 MS. YEATMAN: I'll second that

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 47

1 motion.

2 MR. BUNCH: We have a motion and a

3 second with some additional information with the

4 second and all in favor?

5 MS. YEATMAN: Aye.

6 MR. DARBY: Aye.

7 MR. SORRELL: Aye.

8 MR. BUNCH: Aye.

9 Any opposed?

10 (No response.)

11 MR. BUNCH: Hearing none, motion

12 carries. Take your pods and go with them.

13 MR. KING: Thank you.

14 MR. BUNCH: Thank you.

15 All right. I think that's all the

16 presentations we had today. We'll move right

17 along to Mr. Darby with the treasurer's

18 report.

19 MR. DARBY: Okay. Let me get it

20 pulled up here. You have a treasurer's report

21 in your Dropbox that was put in there fairly

22 late so you might not have had a chance to look

23 at it. If y'all will remember, this is a little

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 48

1 bit longer treasurer's report because our year

2 end was September 30 so I can give you a little

3 recap on it. If you'll remember at last month's

4 meeting, I was telling you we had fallen a

5 little behind on our income levels for --

6 according to budget. We had a great month

7 thanks to pharmacists and pharmacies renewing

8 their license and so we made up the deficit and

9 actually ended up about $400,000 above budget

10 for the fiscal year on -- on the income.

11 Our expenses were -- ended up for the

12 year two percent above budget. Some of that was

13 due to increased personnel costs where we added

14 some personnel, also our longstanding issue with

15 computer services caused us to have a little

16 increase on the expense side but the good news

17 is we had budgeted a deficit of $1.2 million for

18 the fiscal year and we ended up with only a

19 deficit of $879,000, so $347,000 better than

20 what we had budgeted so thanks to the office

21 staff for complying with the budget and thanks

22 to the pharmacists and pharmacies for renewing

23 in a timely manner, so that's the budget for --

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 49

1 I mean that's the treasurer's report for the

2 year ending 9/30/2016.

3 MR. BUNCH: Very good. I will

4 entertain a motion to accept the treasurer's

5 report.

6 MR. SORRELL: I make a motion we

7 accept the treasurer's report.

8 MS. YEATMAN: Second.

9 MR. BUNCH: Motion and a second. All

10 in favor?

11 MR. SORRELL: Aye.

12 MS. YEATMAN: Aye.

13 MR. DARBY: Aye.

14 MR. BUNCH: Any opposed?

15 (No response.)

16 MR. BUNCH: Hearing none, the

17 treasurer's report is accepted. Mr. Darby, good

18 job.

19 All right, let's see, Board minutes,

20 we've got two to vote individually to accept

21 them, so the September 2016 Board business

22 minutes and then the 2016 September interview

23 minutes. I'll entertain a motion on that.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 50

1 MR. DARBY: I'll make a motion that we

2 approve the September 2016 Board business

3 minutes.

4 MS. YEATMAN: Second.

5 MR. BUNCH: All in favor?

6 MS. YEATMAN: Aye.

7 MR. DARBY: Aye.

8 MR. SORRELL: Aye.

9 MR. BUNCH: Hearing no opposition,

10 we'll consider it approved.

11 MR. DARBY: I also make a motion to

12 approve the September 2016 interview minutes.

13 MS. YEATMAN: Second.

14 MR. BUNCH: A motion and a second.

15 All in favor?

16 MR. DARBY: Aye.

17 MS. YEATMAN: Aye.

18 MR. SORRELL: Aye.

19 MR. BUNCH: Any opposed?

20 (No response.)

21 MR. BUNCH: Hearing none, the

22 interview minutes are also accepted.

23 Okay. Eddie, inspector's report.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 51

1 MR. BRADEN: Yes, sir, Mr. Vice

2 President and members of the Board, before I

3 talk about the inspection and investigation

4 report, I wanted to announce the sadness that we

5 have for the passing of a former state drug

6 inspector, Drue Lackey. Mr. Lackey worked for

7 the Board for over 30 years. He was one of the

8 members of the group that had Maurice House and

9 Mr. Lackey and Mr. McDonald and Mr. Carl

10 Limbaugh, but he passed away on October 16 of

11 this year.

12 He had a colorful career. He was in

13 the United States Marine Corps. He retired from

14 the Montgomery police department as chief of

15 police and he is forever known as the person

16 that fingerprinted Rosa Parks in that picture

17 that we all have seen in the history books, so a

18 lot of people don't realize he was a lieutenant

19 at the time he did the fingerprinting of

20 Ms. Parks and he primarily did that for the

21 protection of Ms. Parks, so I just wanted to let

22 that be known.

23 MR. BUNCH: Appreciate that, Eddie.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 52

1 MR. BRADEN: As you see in the

2 inspection and investigation report how many

3 completed inspections that we had and the number

4 of complaints we received and that we completed

5 last month and you see the activities that we

6 were involved in that I always list at the

7 bottom, so if you have any questions, I'll be

8 more than happy to answer them.

9 MR. BUNCH: Okay. Thank you very

10 much. Appreciate it. And Dr. Alverson, do you

11 have a secretary's report?

12 DR. ALVERSON: Yes, sir. We have just

13 received our final letter from the Sunset

14 Committee. There were no findings other than

15 that the Board members and I attend an ethics

16 class because we had contracted with a former

17 board member for some work and although we felt

18 we were in line, the Sunset Committee didn't, so

19 we're very glad to have Sunset over and fiscal

20 audit over and all of those audits over.

21 We have completed the budget. The

22 budget is in your folders that you received and

23 we do need to take a vote to approve the budget

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 53

1 for the upcoming year, so I would ask you,

2 Mr. Chairman, if you could work that into the

3 agenda today.

4 MR. BUNCH: Certainly.

5 DR. ALVERSON: All right. We have

6 contracted for one single cost for computers for

7 this year and next year, which is lower than

8 we've had before and I hope we will never have

9 to hear the treasurer again say our computer

10 costs have been high, but paying two different

11 companies for a while most certainly caused

12 that.

13 The FDA held another 50 state meeting.

14 None of the Board members nor I attended it

15 because we were at the Sunset Committee, but

16 Cristal and Todd and Scott did attend and I

17 would like Cristal just to give you some

18 highlights from that meeting, please.

19 MS. ANDERSON: Okay. Which I do have

20 an informal write-up if you'd like for me to add

21 it to your Dropbox. The FDA is coming across a

22 lot softer now. They're realizing that maybe

23 they can actually collaborate with us as opposed

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 54

1 to forcing us into anything, so they're starting

2 to listen -- they sound like they're starting to

3 listen to what we're saying, the problems we're

4 having and the reasoning behind why we can't

5 agree to some of the things they want to impose

6 as far as a memorandum of understanding. Right

7 now they are pushing that back because 503Bs are

8 taking up a lot of their time and effort --

9 503Bs, outsourcers, so they want to streamline

10 their process and start inspecting those on a

11 yearly basis. They say it's going to get --

12 it's going to be a while to get there but they

13 have also told us that they are going to have an

14 FMD-145, which is their formal closure of an

15 inspection once a facility is compliant so that

16 is how the boards can know that the facility did

17 make all the changes they needed to and they are

18 now in CGMP compliance. I have yet to see one

19 of those but they promise it's on the horizon.

20 They also worked with us on how we're

21 licensing 503Bs at a state level. There's still

22 a lot of discussion and a lot of different

23 directions that state boards are going. They

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 55

1 also reviewed some of the types of compounding

2 inspections that they are performing, both for

3 outsourcing facilities and for your traditional

4 pharmacies that compound. This would include

5 surveillance inspections, which is their risk-

6 based model. This is often 503A facilities or

7 traditional compounders they feel that are --

8 should be pushed into the outsourcing bucket and

9 have stricter CGMP guidelines.

10 They also have for-cause inspections.

11 That's where they have received reports of

12 serious adverse events or sterile practice

13 issues. Thirdly was a compliance follow-up.

14 This is when they come back in and do another

15 483 and then companies can request a 503B

16 reinspection, which they say a reinspection fee

17 of approximately $15,000, they will come back

18 out and reinspect you.

19 They also reviewed guidance drafts.

20 They have recently come out with including

21 commercially available, essential copy,

22 significant difference, and regular or

23 inordinate amounts where they have tried to

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 56

1 better define those vague terms. They have also

2 come out with insanitary conditions at

3 compounding facilities. This not only applies

4 to 503B outsourcers but to traditional

5 pharmacies.

6 Prescription requirements for 503B

7 facilities, they want patient-specific

8 information before you compound and send it.

9 That's where they're making their break from

10 503A to 503B. Some of the states did bring up

11 the point that a lot of these larger processors,

12 the larger outsourcers, don't want to make these

13 small amounts of minute meds that physicians

14 might need for a particular operation or a

15 process they perform in their office, so the FDA

16 had not thought about that. They're

17 reconsidering. They took notes and we also

18 touched on physician compounding, which the FDA

19 really says they do not have a part in that

20 right now. They are kind of pushing onto the

21 states or the medical associations. They also

22 mention CDC might be able to get involved in

23 these type of activities and the public health

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 57

1 department but we know pharmacy boards really

2 don't have that action, at least not here in

3 this state.

4 A couple of states like Ohio have

5 gotten some of that type of legislation passed

6 but it's been difficult and like I said, I have

7 a little bit more detail but that was the main

8 gist of the meeting that we had but it was great

9 to collaborate with some of the other states and

10 see what's out there, and like I said, the FDA

11 does seem more receptive and like they're trying

12 to accommodate state boards a little bit more.

13 They understand that we're trying, we're just --

14 we're seeing things from a different

15 perspective. Thanks.

16 MR. BUNCH: Thank you. Thank you,

17 Cristal.

18 MS. ANDERSON: Yes, sir.

19 DR. ALVERSON: At that meeting they

20 asked that they would appreciate it if state

21 boards could contact their district director

22 just so we could coordinate who's doing what,

23 what problems do you see, and so I did place a

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 58

1 phone call to the director for -- it's the --

2 we're in the New Orleans district but the

3 district office is in Memphis -- or excuse me,

4 Nashville, so I contacted the director there and

5 we got a very nice response from her saying we

6 wish every state was as on top of this as

7 Alabama was, we really appreciate Alabama.

8 There really was not much sharing of information

9 in terms of this is a problem here or we want to

10 identify a pharmacy in any way. It was very

11 broad kind of conversation.

12 They are going to be putting on a

13 training program in Alabama probably in the next

14 couple of months and they've asked us to partner

15 with them in doing that. We said of course we'd

16 be glad to pitch in and do that.

17 We definitely need to start working on

18 legislation to put into statutes that we will be

19 licensing all the various pharmacy businesses,

20 wholesalers, 3PLs, so on and so forth, to come

21 into compliance with FDA requirements and since

22 I believe David told me yesterday the session

23 starts in February, we really need to have that

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 59

1 written soon so we can begin to meet with

2 legislators to make sure that passes.

3 As mentioned in the budgetary report,

4 applications have been coming in. Pharmacists

5 have been great. We are over halfway finished

6 with pharmacists turning in applications but

7 we're kind of surprised that we have not heard

8 from a large portion of pharmacies and we did

9 send a letter to all pharmacies to remind them

10 that they -- they needed to get their

11 applications in.

12 The process is a little more difficult

13 this time because we are asking for more

14 information. We also told the chain pharmacies

15 that there's a way that -- and we will be glad

16 to help them with this if they want that for the

17 demographic information they could cut and paste

18 into each one of their stores places where we

19 need to know officers or owners, that type of

20 thing, so they don't have to repeat that for

21 every store that they have within the state. So

22 that can be done in an easy step and we'll be

23 glad to work with them on that. All right.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 60

1 We're having a lot of pushback in

2 areas, particularly with wholesalers, 3PLs,

3 virtuals, people haven't had to turn in certain

4 information in the past and they don't want to

5 now either and most of these companies have

6 contracted with organizations that that's what

7 they -- what -- all they do, they -- they're an

8 intermediary for you to get licensed in any

9 state you want to be licensed in. So they are

10 licensing specialty organizations and so that's

11 who we're dealing with as opposed to the actual

12 business. They've learned how to, in many cases

13 I'd say, harass us repeatedly. So they call one

14 of us. If they don't get the answer they want,

15 they call another one. Then they go to Jim's

16 office and this keeps going in a circle and

17 we're trying very hard to make sure we're all

18 saying the same thing to the same person but

19 it's taking up a lot of time.

20 One of the more recent questions is we

21 asked for social security and a birth date on

22 owners, which is part of what the federal

23 government has asked us for, and so we wanted to

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 61

1 talk to Jim at some time to ask them what the

2 law actually says about that, what we can, what

3 we can't do, how hard we can push on that. From

4 our viewpoint, it's a mechanism for finding the

5 same person in the computer system, that a

6 person owns six other pharmacies that are also

7 asking for licenses in our state but in the past

8 we haven't been able to put that together so in

9 that sense, that data is helping us.

10 MR. WARD: And it's because we're

11 finding, right, that I think I'm correct to say

12 this -- stop me if I'm not, Susan and Eddie --

13 we have cases where we have an entity that is

14 involved in the operation of a pharmacy and

15 there's an enforcement action and then the

16 owners form a new entity and start up again

17 somewhere else, so that identifying information

18 is important to have. Is that one of the

19 reasons; correct?

20 DR. ALVERSON: And that's exactly

21 what's happening. You know, in the past LLCs

22 hid behind LLCs, which hid behind LLCs, and

23 finding out who actually owned the business was

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 62

1 very difficult but with some of the

2 identification now it's getting easier to find

3 out who actually owns the business, all right,

4 and exactly what Jim said. We're finding

5 business owners who are putting the business in

6 their mother's name, one of their kids' names,

7 you know, anything to keep from being identified

8 as the true owner, so.

9 I have spoken with Logan Gray three or

10 four times this month about the legislative

11 process coming up and we wanted you to know that

12 we had most of the enforcement staff, David

13 Darby, Cristal, and I attended Maltagon this

14 year, which was in Texas -- Austin, Texas, and

15 as usual, it turns out to be a very good meeting

16 because it's very laid back. They had a lot of

17 sessions for people to get together and compare

18 notes, talk about what's a problem in your

19 state. It turns out we're all having the same

20 issues and so we picked up I think good ideas

21 about how we deal with it versus how someone

22 else does and there's a lot of talk about

23 working together and not each one of us facing

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 63

1 the same problem and facing it on our own.

2 One of the issues that we've been

3 tossing around is requiring a VAWD inspection

4 for wholesalers, 3PLs. VAWD is a NABP system.

5 We've gotten a copy of that -- their inspection

6 report and it's most certainly much more than

7 we would ever have on our own and because those

8 are supposed to be GMP, state inspectors have a

9 lot of difficulty doing that. So if you would

10 be interested, I could have someone from NABP do

11 a presentation to the Board to talk about the

12 VAWD inspections, how they work. It would also

13 mean that if a company had had one, they could

14 share it with all other states that are

15 requiring a VAWD inspection so they don't have

16 to repeat it.

17 The inspection is done at the

18 business' expense, not our expense, and I'm just

19 trying to come up with a way that we have common

20 inspection data for all the people who want

21 licenses in our state. So if you're interested,

22 I will arrange for someone to do a presentation

23 and you can ask whatever questions you want.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 64

1 MR. DARBY: Yeah, I would be

2 interested in that.

3 MS. YEATMAN: Yeah.

4 MR. BUNCH: Sounds great.

5 DR. ALVERSON: Okay, all right.

6 That's what's going on.

7 MR. BUNCH: Thank you very much for

8 your always eloquent secretary's report.

9 MR. DARBY: Buddy, I'd point out at

10 our breakout session with the board members we

11 talked a lot about technicians and technician

12 ratios and technician training and it was very

13 interesting to see the differences between the

14 states but there's more and more of a push of

15 increasing ratios. Texas has gone up to a four-

16 to-one ratio. Florida is four-to-one at a

17 retail setting. They are six to one at a call

18 center, so Tennessee can get up to a four to one

19 if two of them are certified.

20 MR. WARD: Are they increasing -- the

21 ones going four to one, are they increasing

22 their duties as well or are their duties staying

23 the same?

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 65

1 MR. DARBY: There was talk about that.

2 Texas is going to a tech check tech program

3 where the techs are actually checking the techs

4 but Texas has some unique situations where they

5 do telepharmacy where you'll have a pharmacy in

6 a remote area and the supervising pharmacist is

7 actually supervising it video -- by video from a

8 different town but yeah, and it's all across the

9 board as far as the training. A lot of the

10 states require PTCB training. Some have their

11 own board-approved programs of training but I

12 think it's something we definitely need to be

13 looking at.

14 MR. WARD: Any of them have the

15 problems with the colleges that we're having?

16 MR. DARBY: They do, yeah, there was

17 talk about that. Louisiana, in particular,

18 mentioned that they were having the same

19 problems with the colleges as far as admitting

20 people who have absolutely no ability to ever

21 get registered as a technician in the state,

22 the -- you know, there are a lot of changes

23 coming with PTCB in the next few years. I think

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 66

1 it's in 2020 that to take -- to sit for the PTCB

2 test, you'll have to pass an ASHP approved

3 program, which is basically going to one of

4 these colleges which will greatly increase the

5 expense for these people to become technicians

6 and limit their access.

7 Some of the states accept the ASEPT

8 like we do but you have some like Texas that

9 don't. Louisiana does not, so just in my

10 conversations, I like the Florida approach where

11 they don't require a particular certification

12 board. They require a board-approved training

13 program and it also gives them up to a year to

14 pass that thing so -- because the problem that

15 retail pharmacists have in particular is that

16 you go out to hire a tech, you need a tech

17 today. You don't need to wait a year for

18 somebody to go to school, so it gives a pathway

19 for somebody to get some on-the-job training.

20 MR. BUNCH: On most of those, are they

21 grandfathering in the techs and this is new

22 techs coming on the scene?

23 MR. DARBY: Yeah, because I asked that

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 67

1 question if they're grandfathering in the people

2 and they are.

3 MR. WARD: That's not a -- that's not

4 a correct term anymore.

5 MR. DARBY: Grandmothering?

6 DR. ALVERSON: Grandpersoning?

7 MR. WARD: Grandperson.

8 MR. DARBY: Grandparenting. The tech

9 is real interesting, they require you to be PTCB

10 certified to become a tech but they don't

11 require you to maintain a PTCB certification.

12 MR. BUNCH: They don't have to do any

13 kind of like special CE or anything?

14 MR. DARBY: No, no, they can come --

15 once they pass it, they're good but then they

16 have to do their like three hours CE every year

17 and they're good. So it was just interesting to

18 see other people's approaches to it.

19 MR. BUNCH: Yeah, that's good. That's

20 good information. Very good. All right.

21 Let's see, we are down to the

22 attorney's report. Mr. Ward, do you have

23 anything to share with us?

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 68

1 MR. WARD: Plenty but not -- not

2 anything other than in the executive session.

3 MR. BUNCH: All right. Any old

4 business that we need to take up?

5 Still under new business, we'll

6 entertain a motion to approve the new budget,

7 the 2016-2017 budget. I guess that's a good

8 place to do that. Is that good? All right.

9 I'll entertain a motion to approve the budget.

10 MR. DARBY: I'll make a motion to

11 approve the budget but first let me -- can I

12 just highlight a couple of things. It's a very

13 realistic budget, one that I think reflects what

14 our true expenses are and our best guestimate of

15 what our income will be.

16 If you compare the two -- what we did

17 in 2016 and 2017, y'all have heard me talk many

18 times that we're basically on a two-year type

19 budget because one year we operate at a deficit

20 and the next year at a surplus. When you

21 combine the two, it fairly well nets out to be

22 an even where it says, you know, I told you we

23 lost 879,000 this past year. We're budgeted to

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 69

1 actually have a surplus of about a million

2 dollars in 2017, which sounds like a lot of

3 money until you know that you lost 900,000 the

4 year before, so.

5 MR. BUNCH: We make money one year and

6 we don't make so much money the next year.

7 That's just the way it works.

8 DR. ALVERSON: Just so it's in the

9 minutes, we received a letter from the

10 legislature from one of the fiscal

11 responsibility committees wanting to know what

12 we're planning to do with any excess money that

13 we might have to roll over and so we will have

14 to respond to that and I think it's important

15 that we put into that letter exactly what David

16 said, we do have excess money one year.

17 MR. BUNCH: One year, yeah.

18 DR. ALVERSON: And it looks like why

19 don't we just grab that money but you can't.

20 MR. BUNCH: Right.

21 MR. DARBY: Well, and not only that,

22 we're going to have a lot more expenses with

23 some of mandates the federal government is

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 70

1 putting on us --

2 DR. ALVERSON: Correct.

3 MR. DARBY: -- with the new

4 registrations and licensing and the inspections

5 that come along with that.

6 MR. BUNCH: Just the inspections we're

7 doing now with added -- so many compounding

8 pharmacies out there, it's taking time and money

9 to do. So yeah, we need to without a doubt

10 clarify what we -- what we do.

11 DR. ALVERSON: Right.

12 MR. BUNCH: It's easy to look at a

13 picture and say, golly, they've got lots of

14 money but it's not always exactly the way it

15 looks.

16 DR. ALVERSON: Right.

17 MR. BUNCH: So we have a motion?

18 MR. DARBY: With that, I make a motion

19 that we approve the 2017 budget as presented.

20 MS. YEATMAN: Second.

21 MR. SORRELL: Second.

22 MR. BUNCH: Motion by Mr. Darby.

23 Second by Ms. Yeatman. All in favor?

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 71

1 MS. YEATMAN: Aye.

2 MR. DARBY: Aye.

3 MR. SORRELL: Aye.

4 MR. BUNCH: Aye.

5 Any opposed?

6 (No response.)

7 MR. BUNCH: Hearing none, the budget

8 is approved for next year. I think that's

9 everything on our list.

10 MS. YEATMAN: I've got some new

11 business.

12 MR. BUNCH: You've got some business.

13 Oh, I'm sorry. I'm moving too fast here.

14 MS. YEATMAN: No, just for the record,

15 Susan, your evaluation will be coming up and so

16 as a board, we are asking that you submit to the

17 Board members a list of accomplishments for this

18 previous year, things that you're currently

19 still working on and what you're planning on

20 achieving for next year so that we can use that

21 when we sit down and do your evaluation. If you

22 would get that to us maybe by next board meeting

23 would be a good deadline.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 72

1 DR. ALVERSON: Yes.

2 MS. YEATMAN: And then also in looking

3 at our staff, we also would like to encourage

4 you to be looking into hiring another

5 receptionist so that we might be able to better

6 utilize the staff we have to continue to be able

7 to answer and provide what the public health

8 needs from our standpoint here at the office so

9 if you could help in identifying another staff

10 member.

11 DR. ALVERSON: All right.

12 MR. DARBY: Who likes to answer the

13 phone.

14 MS. YEATMAN: Who likes to answer the

15 phone.

16 DR. ALVERSON: Especially when you

17 call.

18 MR. DARBY: No, when other people

19 call. I can normally get people to answer a

20 call when I call.

21 MR. BUNCH: Any other --

22 MS. YEATMAN: That's all.

23 MR. BUNCH: -- any other new business?

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 73

1 All right. Let's see now, I've got this thing

2 here I have to read into the minutes and make

3 sure it's correct.

4 I will now entertain a motion for the

5 Board to go into executive session for the

6 purpose of discussing qualifications and

7 competency of those regulated by this Board and

8 pending cases. This executive session will

9 begin at blank -- let's see what blank is -- a

10 quarter until 11:00 and we'll come out at a

11 quarter after 11:00. When the Board returns to

12 its public meeting, we will only vote on matters

13 discussed during the executive session and then

14 adjourn.

15 Mr. Ward, do you need to make a

16 statement for the record?

17 MR. WARD: Yes, sir, yes, sir, that as

18 an attorney licensed to practice law in the

19 State of Alabama, one of the purposes for the

20 executive session will be to discuss and

21 consider resolution of pending cases.

22 MR. BUNCH: All right. And we will

23 need to do an individual vote so do we have a

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 74

1 motion to retire into executive session?

2 MR. DARBY: I make a motion we retire

3 into executive session.

4 MR. BUNCH: Motion by Mr. Darby.

5 MS. YEATMAN: Second.

6 MR. BUNCH: Second by Ms. Yeatman.

7 And Mr. Sorrell, how do you vote?

8 MR. SORRELL: Yes.

9 MR. BUNCH: Mr. Darby?

10 MR. DARBY: Yes.

11 MR. BUNCH: And Ms. Yeatman?

12 MS. YEATMAN: Yes.

13 MR. BUNCH: I also vote yes, so we

14 will now adjourn into executive session. Thank

15 you very much for coming today.

16

17 (Whereupon, a recess was taken for

18 executive session from 10:35 a.m. to

19 12:40 p.m.)

20

21 MR. BUNCH: This is the Alabama Board

22 of Pharmacy. We are now coming out of executive

23 session. And let's see, Eddie, you don't have

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 75

1 any of the cases, do you?

2 MR. BRADEN: No, sir.

3 MR. BUNCH: All right.

4 MR. WARD: Ralph moves that Donna

5 Yeatman be given authority to act on behalf of

6 the Board in relation to a negotiation of

7 possible settlement of a lawsuit filed by the

8 Board against Virginia College.

9 MR. SORRELL: So moved.

10 MR. BUNCH: Second. All in favor?

11 MR. DARBY: Aye.

12 MS. YEATMAN: Aye.

13 MR. SORRELL: Aye.

14 MR. BUNCH: Aye. None opposed.

15 Motion carries.

16 Is there any other business to come

17 before the Board at this time?

18 (No response.)

19 MR. BUNCH: Hearing none, so I'll

20 entertain a motion to adjourn. All in favor?

21 MS. YEATMAN: Aye.

22 MR. DARBY: Aye.

23 MR. BUNCH: Aye.

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 76

1 MR. BUNCH: Any opposed? No.

2 We are now adjourned.

3

4 (Whereupon, the meeting was adjourned

5 at 12:43 p.m.)

6

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Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 77

1 CERTIFICATE

2

3 STATE OF ALABAMA

4 SHELBY COUNTY

5

6 I, Sheri G. Connelly, RPR, Certified

7 Court Reporter, hereby certify that the above

8 and foregoing hearing was taken down by me in

9 stenotype and the questions, answers, and

10 statements thereto were transcribed by means of

11 computer-aided transcription and that the

12 foregoing represents a true and correct

13 transcript of the said hearing.

14 I further certify that I am neither of

15 counsel, nor of kin to the parties to the

16 action, nor am I in anywise interested in the

17 result of said cause.

18

19

20 /s/ Sheri G. Connelly

21 SHERI G. CONNELLY, RPR

22 ACCR No. 439, Expires 9/30/2017

23

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 78 WORD INDEX 63:4 accept 49:4, 7, 20 Affordable 29:9 66:7 aftercare 11:7, 8 < $ > < 4 > accepted 49:17 agenda 2:5 6:3, 5, $1.2 48:17 439 77:22 50:22 14 8:22 37:10 $15,000 55:17 46 2:21 access 16:16 20:12 53:3 $347,000 48:19 47 2:22 66:6 agree 43:20 54:5 $400,000 48:9 483 55:15 accommodate 57:12 ahead 9:2 21:20 $879,000 48:19 49 3:2 accomplish 18:14 37:11 accomplishments ALABAMA 1:2, 19, < 1 > < 5 > 71:17 21 5:18 7:13 8:1, 1 28:3 5 26:7 accountability 3, 13, 15, 17 12:13, 10:35 74:18 50 3:5, 7 53:13 18:21 19:4, 13 21 21:7 28:2 106 24:18 503A 55:6 56:10 ACCR 77:22 37:22 38:6 46:17 11:00 73:10, 11 503B 55:15 56:4, 6, achieving 71:20 58:7, 7, 13 73:19 111 1:20 10 Act 29:9 75:5 74:21 77:3 12 2:10 503Bs 54:7, 9, 21 action 57:2 61:15 alert 26:10 12:40 74:19 50-foot 15:5 17:5 77:16 aligned 30:19 12:43 76:5 51 3:8 activities 52:5 allow 22:22 27:21 15 10:8 52 3:9 56:23 allowing 12:11 154 9:8 actual 17:21 32:19 16:8 23:13 16 51:10 < 6 > 40:15 60:11 ALSHP 7:15 18 10:7 6 2:4, 6, 7 13:9 add 24:5 38:20, 22 Alverson 4:10 680-X-2-.18 13:8 43:12 44:2, 3 52:10, 12 53:5 < 2 > 46:19 53:20 57:19 61:20 64:5 2015 10:10 < 7 > added 29:13 38:8 67:6 69:8, 18 70:2, 2016 1:11 3:4, 6 70 3:13 44:15 48:13 70:7 11, 16 72:1, 11, 16 10:6 11:18 29:12 71 3:15 addition 38:15 amendment 46:22 49:2, 21, 22 50:2, 72 23:13 additional 43:12 amount 20:6 23:3 12 68:17 73 3:17 44:2, 4 47:3 amounts 55:23 2016-2017 3:11 75 3:21, 22 additions 27:11 56:13 68:7 77 11:6 address 20:13 31:9 Anderson 4:11 2017 68:17 69:2 adherence 30:13 53:19 57:18 70:19 77:22 < 8 > adjourn 3:22 Andy 38:2 2020 66:1 879,000 68:23 73:14 74:14 75:20 announce 51:4 21 3:4, 6 13:13 adjourned 76:2, 4 answer 11:13 46:9 24 24:20 25:2 < 9 > adjustment 25:8 52:8 60:14 72:7, 24-hour 13:18 9 2:8 3:4, 6 49:2 administration 12, 14, 19 26 1:11 77:22 19:18 answered 38:4 27 2:13 9:10 1:13 administrator 18:8 answers 77:9 29 2:14 10:10 900,000 69:3 25:17 anymore 67:4 admitting 65:19 anywise 77:16 < 3 > < A > adopt 6:3, 4 APA 8:6 30 48:2 49:2 51:7 a.m 1:13 74:18 adopted 6:15 appears 43:3 77:22 ABC 34:16 ADPH 16:15 applications 59:4, 6, 33 10:13 ability 17:20 65:20 adverse 30:1 55:12 11 35242 1:21 able 16:17 19:23 adversities 29:23 applies 56:3 36 2:17 20:21 56:22 61:8 Affinity 2:14 7:10, appointment 35:15 37 2:18 10:7 72:5, 6 11 28:23 29:4 Appreciate 12:2, 10 3PLs 58:20 60:2 absolutely 65:20 30:2 36:2, 6 21:11 28:15, 22

Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 79 51:23 52:10 57:20 available 16:23 Birmingham-Southe Brooks 4:13 8:19, 58:7 55:21 ast 39:22 41:5 19 approach 66:10 Aye 6:9, 10, 11 Birmingham-West bucket 55:8 approaches 67:18 28:7, 8, 9, 10 36:10, 39:23 Buddy 4:4 5:19 appropriately 29:21 11, 12 47:5, 6, 7, 8 birth 60:21 64:9 Approval 3:3 13:7 49:11, 12, 13 50:6, Bishop 5:2 7:13, budget 3:11 48:6, 15:11 21:3, 9 30:4 7, 8, 16, 17, 18 71:1, 13 9, 12, 21, 23 52:21, approve 2:5, 15, 19, 2, 3, 4 75:11, 12, 13, bit 8:23 10:11 22, 23 68:6, 7, 9, 11, 23 3:11 27:15 14, 21, 22, 23 12:19 14:13 29:8 13, 19 70:19 71:7 36:2, 5 46:16 50:2, 38:14 48:1 57:7, budgetary 59:3 12 52:23 68:6, 9, < B > 12 budgeted 48:17, 20 11 70:19 back 15:3 23:4 blank 73:9, 9 68:23 approved 13:8 26:4, 15, 21 38:3, blind 17:19 19:1 buds 42:20 35:17 50:10 66:2 11 43:11 46:2 27:4 Bunch 3:21 4:4 71:8 54:7 55:14, 17 blister 13:3 5:17, 19 6:7, 12, 14 approving 40:10 62:16 blood 42:2 8:21 11:23 12:3 approximately background 29:9 BOARD 1:2, 9, 19 21:14 25:10 27:10, 55:17 backup 14:1 4:3, 18, 19 5:18 14, 18 28:5, 10, 13, area 65:6 bank 14:18 15:2 6:1, 21, 22 8:14, 16, 22 30:17 33:21 areas 41:18 60:2 16:5, 12, 16 17:8, 18, 19 11:12 12:10 34:5, 12, 16, 19 Arendall 8:5 13 18:9 21:15 24:5 27:12 35:21 36:1, 8, 12, arrange 63:22 Barker 4:22 7:7, 7 30:18 35:22 38:10 15 37:2, 9, 16 46:5, arrive 41:14 based 18:2 19:7 43:9 45:8 49:19, 8, 12 47:2, 8, 11, 14 ASEPT 66:7 55:6 21 50:2 51:2, 7 49:3, 9, 14, 16 50:5, ASHP 66:2 basically 66:3 52:15, 17 53:14 9, 14, 19, 21 51:23 asked 19:20 44:1 68:18 63:11 64:10 65:9 52:9 53:4 57:16 45:1 57:20 58:14 basis 25:12 54:11 66:12 71:16, 17, 22 64:4, 7 66:20 60:21, 23 66:23 bear 5:20 73:5, 7, 11 74:21 67:12, 19 68:3 asking 10:17 beginning 12:6 75:6, 8, 17 69:5, 17, 20 70:6, 45:17 59:13 61:7 behalf 75:5 board-approved 12, 17, 22 71:4, 7, 71:16 believe 24:12 65:11 66:12 12 72:21, 23 73:22 assisted 12:22 58:22 boards 54:16, 23 74:4, 6, 9, 11, 13, 21 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October 26, 2016 80 called 14:18 29:13 Chris 5:6 7:20 company 29:4 contract 9:11 Cammie 5:7 7:22 circle 60:16 38:2 63:13 30:20 35:3 capabilities 17:1 clarifications 27:11 compare 62:17 contracted 52:16 CAPS 8:7 clarify 70:10 68:16 53:6 60:6 CardinalHealth class 52:16 competency 73:7 contracts 9:9 7:16 clients 37:6 competitors 41:19 control 19:22 cards 13:4 clinical 42:8 complaints 52:4 controlled 18:4, 11 Care 8:11 12:15, close 41:2, 17 complete 13:14 23:22 24:17 21 29:9, 12 30:6, closed-door 12:19 15:12 conversation 58:11 10, 12 closure 54:14 completed 52:3, 4, conversations 66:10 career 51:12 Cloud 14:21 16:19 21 Cook 5:3 7:15, 15 careful 11:22 CMS 29:10, 12 completion 29:14 coordinate 57:22 Carl 51:9 Coker 4:19 6:22, Compliance 4:11 copies 37:15 carries 28:14 22 33:15 54:18 55:13 copy 37:17 55:21 36:15 47:12 75:15 collaborate 53:23 58:21 63:5 case 33:21, 23 57:9 compliant 32:3 Corps 51:13 cases 34:17 35:3 College 3:20 75:8 33:4 54:15 correct 14:10 60:12 61:13 73:8, colleges 65:15, 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15:12 16:3 cubies 18:1 decide 26:6 Director 4:11 18:7, 19:8, 17, 20 20:4, cumbersome 14:3 decides 26:3 9 23:7 25:16 14, 16, 17 25:23 curiosity 21:17 decrease 18:17, 22 57:21 58:1, 4 29:17, 20 30:1 current 9:13 decreased 19:16, 18 discrepancies 19:2 32:20 51:5 44:17, 19 decreasing 20:15 21:2 drugs 23:22 26:15 currently 12:21 deem 21:3, 9 discrepancy 23:22 29:20 13:3, 12 40:22 deficit 48:8, 17, 19 discuss 73:20 due 17:2 48:13 43:1 71:18 68:19 discussed 73:13 duties 64:22, 22 customers 13:3 define 29:16 56:1 discussing 73:6 cut 59:17 defined 29:16 discussion 54:22 < E > definitely 18:22 disease 33:11 earlier 16:2 < D > 23:16 24:23 25:5 dispensing 2:11 Easier 20:7, 11, 12 D.O.N 25:16 58:17 65:12 12:15 13:10 14:11 62:2 Daniel 4:15 8:13, delivered 16:10 16:21 28:1 easily 21:1 13 delivering 22:3 district 57:21 58:2, easy 59:22 70:12 Darby 2:5, 12, 16, delivery 13:17 3 Eddie 4:12 5:11 20 3:5, 7, 12, 16 16:11 diversion 18:17, 23 8:7 50:23 51:23 4:5 6:4, 11 11:20 demographic 59:17 19:13 61:12 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Freedom Court Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 82 14:2 11, 20 54:15, 16 Florida 41:12 41:12 entity 61:13, 16 facility-driven 11:7 64:16 66:10 getting 32:20 62:2 errors 19:19 21:2 facility's 20:13 flow 39:13 gist 57:8 especially 18:23 facing 62:23 63:1 FMD-145 54:14 give 6:17 24:14 46:13 72:16 fairly 47:21 68:21 folders 52:22 37:12 48:2 53:17 essential 55:21 fallen 48:4 follow-up 30:8 given 46:19 75:5 Establishment 2:4 family 14:12 55:13 gives 66:13, 18 ethics 52:15 far 30:15 32:1, 3, for-cause 55:10 glad 52:19 58:16 evaluate 30:8 5 43:23 54:6 65:9, forcing 54:1 59:15, 23 evaluation 3:15 19 foregoing 77:8, 12 Glenn 4:14 8:15 9:18 10:3, 20 fast 71:13 Foreman 2:10 7:1, GMP 63:8 71:15, 21 favor 6:8 28:6 1 12:9, 12 21:18, go 9:2 11:9, 10 events 55:12 36:9 47:4 49:10 21 22:1, 10, 16, 22 16:6, 7 18:3 20:20 everybody 6:16 50:5, 15 70:23 23:2, 12, 15 24:3, 7, 22:19 25:18 37:11 40:21 75:10, 20 11, 16, 22 25:5, 9, 42:7 45:15 47:12 evident 15:19 22:9 FDA 53:13, 21 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Reporting, Inc 877-373-3660 Board Meeting Minutes October 26, 2016 83 Grandmothering 17 improved 29:22 Inspector's 3:8 67:5 held 53:13 incentive 42:7 50:23 Grandparenting help 5:22 10:17 include 9:11 55:4 institutional 11:8 67:8 14:9, 10, 23 15:2 includes 9:10 11:4 13:8 Grandperson 67:7 18:22 19:16 23:18 13:22 instructed 11:10 Grandpersoning 29:15 42:7, 20 including 29:23 insurance 35:4, 5 67:6 44:13 59:16 72:9 55:20 integration 32:1 Gray 62:9 helped 10:15 income 48:5, 10 interested 31:2 Great 23:1 48:6 helping 61:9 68:15 63:10, 21 64:2 57:8 59:5 64:4 Heritage 7:20 Incorporated 8:8 77:16 greatly 66:4 hey 20:19 23:5 increase 48:16 interesting 64:13 group 12:23 40:1, 26:11, 12 66:4 67:9, 17 3 46:3 51:8 hid 61:22, 22 increased 18:16 intermediary 60:8 groups 39:16 high 53:10 48:13 interventions 30:5 40:16 46:16 highlight 68:12 increasing 20:6, 15 interview 3:6 guess 6:2 12:3 highlights 53:18 64:15, 20, 21 32:13 49:22 50:12, 27:10, 15, 16 34:5 HIPAA 32:3 independent 12:20 22 35:3 46:12 68:7 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