W Michael Trout 9453 Burlington Place Boca Raton, FL 33434 Mr !hri" #ri$arr%, &'ecuti(e )irector !L Bru*bac+ Pri*ar% !

are !linic" 2,0 0th -(enue .orth Pal* /0ring", FL !on"u*er !o*0laint"1

October 7, 20 3

2 There i" no in3or*ation 0o"te4 in the !linic" to e4ucate client" about the nature o3 an F56! 7Fe4erall% 5uali3ie4 6ealth !enter8, an4 it9" uni:ue *i""ion to 0ro(i4e P-T#&.T )R#;&. care2 22 There i" no in3or*ation 0o"te4 to noti3% con"u*er" about the F56! Boar4 o3 )irector" *o4el, o3 <hich 5 = M>/T con"i"t o3 clinic >/&R/, an4 <hen an4 <here 0ublic *eeting" occur2 32 There i" no in3or*ation 0o"te4 in the !linic" about the co"t o3 "er(ice", nor i" there co*0rehen"i(e in3or*ation 0re"ente4 about all 3inancial con"u*er o0tion" a(ailable on the 6!) <eb0age regar4ing the !linic"2 The !linic" 4o not at thi" ti*e *aintain an in4e0en4ent 4e4icate4 <eb"ite 7a *atter o3 "e0arate concern82 #t i" critical that the Bru*bac+ BO) ta+e 3ull control o3 it" 0ublic relation" an4 *e""aging 3unction", <hich are a*ong +e% authoritie" o3 the Boar42 42 The actual *enu o3 co"t o3 "er(ice" i" un?tran"0arent, con3u"ing, an4 e'ce""i(e 3or lo<er inco*e con"u*er", an4 i" not *a4e clear to 0atient" 0rior to 4i"0en"ation o3 care 7"o that 0atient" 4o .OT enter encounter <ith 3ull% in3or*e4 con"ent regar4ing 3inancial re"0on"ibilitie"82 The !linic" recentl% relea"e4 a three?tiere4 3ee "che4ule li"ting charge" at or abo(e 3ee" charge4 in the general *ar+et area in the 0ri(ate *ar+et2 The highe"t 3ee, @ 30 i" e:ual to 3ee" charge4 to "ee a 0h%"ician at *an% urgent care clinic", %et <hile "er(ice" at the !linic" are a(ailable to an%one, the !linic"9 *i""ion i" to 0articularl% "er(e *e4icall% un4er"er(e4 7lo< inco*e8 0o0ulation"2 Patient" can 0re"ent at Walgreen" or !;/ clinic" an4 con"ult <ith an R. 0ro(i4er 3or about @,02 -t the "a*e ti*e, the !linic" ha(e recentl% a00ro(e4 a ca0itate4 agree*ent <ith the 6ealth !are )i"trict o3 Pal* Beach !ount% to 0ro(i4e unli*ite4 0ri*ar% care "er(ice"Aencounter" to 0atient" enrolle4 through the 6!) 3or @40 0er *onth 3or an in4i(i4ual2 Thi" "i*0li3ie4 an4 a33or4able 3ee "che4ule "houl4 be a(ailable to all !linic con"u*er", along <ith the a00ro0riate 4i"count" 4eter*ine4 in the "li4ing 3ee "cale "che4ule2 # Bu"t got *% 3ir"t "tate*ent 3ro* the !linic" that "a%" # o<e @ 752 .othing i" ite*i$e4, Bu"t "a%" # o<e @ 752 .othing to "a% i3 thi" i" a !linic charge*a"ter 3ee, <ith or <ithout "li4ing "cale 3ee 4i"count" a00lie42 - P6C/#!#-. that <e 0a% @ ,0,000 0er %ear co"t" an a(erage a00ro'i*atel% @D0 0er hour, not inclu4ing ancillar% co"t"2 )e0en4ing on the a(erage 0atient loa4, i3 the 0h%"ician i" "eeing 4 0atient" an hour, there i" a ba"e co"t o3 @20 0er a00oint*ent2 #3 the 0h%"ician i" "eeing , 0atient" in an hour, the co"t re4uce" to @ 3233, an4 D 0atient" 0er hour to @ 02 -n -R.P co*0en"ate4 at @,5,000 0er %ear co"t" an a(erage a00ro'i*atel% @32250 0er hour, not inclu4ing ancillar% co"t"2 #3 the -R.P i" atten4ing 4 0atient" 0er hour, there i" an a00ro'i*ate ba"e co"t o3 @D2 2 0er a00oint*ent2 #3 <e increa"e the 0atient loa4 to , 0er hour, the relati(e co"t 0er a00oint*ent re4uce" to @524 , an4 i3 <e increa"e the 0atient loa4 to D 0er hour, the co"t re4uce" to @420, 0er 0atient2 52 /er(ice -rea E Brochure" 0ubli"he4 b% the !linic" *ight be *i"con"true4 b% rea4er" to in3er that "er(ice" are li*ite4 to re"i4ent" o3 Pal* Beach !ount%, <hen in 3act, a" Fe4erall% 5uali3ie4 6ealth !enter", "er(ice" are a(ailable to an% 0atient <ho 0re"ent" at a Bru*bac+ !linic, <ithout 0reBu4ice2 There are no /er(ice -rea 4i"clai*er" 0o"te4 in the clinic"2 ,2 !on"u*er" at the !linic" "hare a large <aiting roo* <ith 0atient" o3 the )e0art*ent o3 6ealth2 The )O6 0ro(i4e" a *ea"ure o3 0ri(ac% b% calling 0atient" b% a nu*ber "%"te*2 !linic 0atient" na*e" are announce4 lou4l% in the roo*, o33ering no ele*ent o3 0ri(ac%2 72 )uring the 0atient encounter, but 0re(iou" to the i""uance o3 an% 0re"cri0tion", the 0atient i" a"+e4 to na*e a 0re3erre4 0har*ac%2 There i" no 4i"cu""ion o3 4i"count 0har*aceutical" "ub"i4i$e4 b% the 3e4eral go(ern*ent 3or "o*e 0atient"2 #n the ca"e that 0re"cri0tion" are i""ue4, there i" no ti*e allotte4 3or the 0atient to "ho0 0har*acie" 3or the 0articular 4rug" that *a% be nee4e42 #n the ca"e o3 t<o or *ore 0re"cri0tion", a con"u*er "houl4 be able to loo+ 3or the *o"t a33or4able o0tion 3or each *e4ication2 #n *% e'0erience, the 0har*ac% that recei(e4 *% 0re"cri0tion" ha4 a co"t 3ull% 4ouble the a*ount o3 a co*0eting 0har*ac%, but # <a"n9t able to a"certain thi" in3or*ation until # ha4 co*0lete4 *% encounter, an4 4e0arte4

the !linic2 There i" no 0rinte4 0re"cri0tion 3or 0atient" to carr% out, a" 0re"cri0tion" are 3or<ar4e4 electronicall% to a 0har*ac%2 -" a 3or*er *e*ber o3 the boar4 o3 4irector" o3 the clinic", # "0eci3icall% brought the *atter o3 thi" con"u*er 4ile**a to the attention o3 clinic "ta33, an4 <a" a""ure4 that it <oul4 be loo+e4 into2 The 0roble* 0er"i"t", an4 i" re3lecti(e o3 a 4i"regar4 to !linic 0atient"Acon"u*er"2 The "i*0le"t "olution, i", o3 cour"e, to 0ro(i4e 0atient" <ith a (ali4 carr%?out tra4itional 0rinte4 0re"cri0tion, that 0atient" can 0re"ent to the 0har*acie" o3 their 7con"u*er8 choice2 D2 >0on co*0letion o3 the 0atient encounter, 0atient" are re3erre4 to a <in4o< in the large <aiting area to recei(e 0re"cri0tion 4e"cri0tion" an4 4o"e or4er", an4 re3erral"2 #3 the 0er"on <ho occu0ie" that "tation i" not "o*eone <ith a nee4 to +no< 0ri(ate 0atient in3or*ation, there "houl4 be an alternati(e "%"te*, 0o""ibl% <hereb% the 0ro(i4er" ha(e an area 3or their o<n 0rinter, an4 a *e4ical technician 0rint" an4 4eli(er" tho"e to the 0atient, an4 an"<er" an% la"t :ue"tion" the 0atient ha" in a 0ri(ate area a<a% 3ro* the 0ro'i*it% o3 other 0atient" in the <aiting roo*2 92 Recentl%, the !linic" boar4 <a" 0re"ente4 <ith a "et o3 u04ate4 out"i4e 0ro(i4er 7re3erral8 contract" 3or (ariou" 0ro(i4er" throughout the count%, inclu4ing "e(eral ho"0ital", b% the "ta33 o3 the 6ealth !are )i"trict2 The !linic9" Boar4 o3 )irector" <a" not con"ulte4 0rior to the 4e(elo0*ent o3 the u04ate" to the"e contract"2 #n the interi* o3 the ti*e <hen original contract" <ere negotiate4, there ha(e been i*0ortant e(ent" in the national health care arena2 For one, the Oba*a a4*ini"tration ha" begun relea"ing "o calle4 Fcharge*a"terG 3ee" charge4 3or the *o"t co**on 0roce4ure" at ho"0ital" aroun4 the nation2 -nal%"i" o3 the 4ata "ho<" that *uch o3 the ti*e, ho"0ital" charge the unin"ure4 an4 *e4icall% un4er"er(e4 at rate" *uch higher than their "tan4ar4 rei*bur"e*ent rate", ba"e4 on their charge*a"ter"2 - charge*a"ter i" "i*ilar to a *anu3acturer" li"t 0rice, but a" it turn" out, not the cu"to*ar% charge" that are -!T>-LLC P-#) to ho"0ital" b% in"urance an4 0ro(i4er grou0", inclu4ing 0ri(ate in"urer" an4 al"o Me4icareAMe4icai4 rei*bur"e*ent rate"2 -" !linic con"u*er" rel% on the !linic" to a4(ocate 3or the*, it "ee*" "o*e thought "houl4 ha(e been gi(en b% the !linic Boar4 o3 )irector" to en"ure that in the ca"e o3 Bru*bac+ re3erral" to the"e 0ro(i4er", 0atient" "houl4 be 0ri(ilege4 to the *o"t 3a(orable 3ee "che4ule" 0re4o*inant in the in4u"tr%2 6o<e(er, there i" no language in the"e contract" to a""ure an% "uch 3air treat*ent o3 Bru*bac+ re3erral"2 For a little bac+"tor% on the 4e(elo0*ent" in ho"0ital 0ricing tran"0arenc%, 0lea"e re3er to an in3or*ati(e article b% Laura Hreen, o3 the Pal* Beach Po"t9" Wa"hington Bureau that can be "een at1 htt01AA<<<2*%0al*beach0o"t2co*Ane<"Ane<"AlocalAat? ho"0ital"?3ull?0rice?3or?unin"ure4AnCMFPA an4 another in3or*ati(e 0iece 3ro* Bloo*berg hea4line4 F>nin"ure4 -*erican" Het 6it With Bigge"t 6o"0ital Bill"G at1 htt01AA<<<2bloo*berg2co*Ane<"A20 3?03? Aunin"ure4?a*erican"?get?hit?<ith?bigge"t?ho"0ital? bill"2ht*l 02 -" a 3or*er *e*ber o3 the boar4 o3 4irector" o3 the !linic", # gaine4 an in"ight into the general culture o3 the organi$ation2 #t i" *% ob"er(ation that there i" a 4%"3unctional relation"hi0 bet<een !L Bru*bac+ Pri*ar% !are !linic" an4 it9" co?a00licant, the 6ealth !are )i"trict o3 Pal* Beach !ount%, "o *uch "o, that the 0ri*ar% *i""ion o3 the Bru*bac+ F56! to be an #.)&P&.)&.T, P-T#&.T )R#;&. ORH-.#I-T#O. i" threatene42 6!) "ta33 are <or+ing 4iligentl% to "%"te*aticall% u"ur0 all +e% 0o<er" an4 authoritie" o3 the !linic9" BO), lea(ing the BO) to be e""entiall% a rubber "ta*0 co**ittee "er(ing at the 0lea"ure o3 6!)2 While the &'ecuti(e )irector i" "u00o"e4 to "er(e at the 0lea"ure o3 the !L Bru*bac+ BO), it i" clear that 6!) e'ecuti(e "ta33 act ina00ro0riatel% a" the )irector9" "u0er(i"or, inter3ering <ith the )irector9" 3i4uciar% 4ut% to "er(e at the 0lea"ure o3 the !L Bru*bac+ BO)2 One nee4" onl% to "tu4% the 4ialogue" in the 0ublic recor4 7*inute" o3 0ublic *eeting"8 to (eri3% thi" ob"er(ation2 With the a44ition o3 "e(eral ne< Boar4 *e*ber" that are u"er", # ho0e to "ee the Boar4 4e(elo0 into a trul% in4e0en4ent agenc% that guar4" an4 0rotect" it9" *i""ion, an4 i" a bona3i4e a4(ocate 3or the 0atient" an4 con"u*er" that utili$e it9" "er(ice"2 >n3ortunatel%, "o*e o3 the long"tan4ing *e*ber" o3 that Boar4, hol4o(er" 3ro* a 0re(iou" a4(i"or% boar4 to the count%9" )e0art*ent o3 6ealth, 4o not "ee* <illing to 0ut the ti*e an4 e33ort in to un4er"tan4ing their *i""ion2 Mr2 )a(i4 Jen4le 3re:uentl% "tate" that he i" 0re""e4 3or ti*e, an4 <oul4 li+e to get ho*e2 M"2 /hirle% Barne" White, currentl% acting chair a3ter 0re"i4ing o(er the unBu"t re*o(al o3 the 3or*er chair, i" al"o 3re:uentl% hear4 to "a% that "he ha" other 0re""ing obligation"2 The"e are har4l% the rall% "logan" 3or 4e4icate4 *e*ber" o3 thi" i*0ortant boar42 Thi" agenc% cannot continue to 0reten4 to be an F56!, Bu"t to collect *one% 3ro* 6R/-2 The "ituation, a" it "tan4", i" nothing le"" than a corru0tion o3 the 0ortion" o3 Patient Protection an4 -33or4able !are -ct that go(ern the F56! 0rogra* *o4el2 2 -ccor4ing to M" -rlene Wal+er 7-<al+erKhr"a2go( 40425,224 508 ProBect O33icer <ith 6R/- 3or the !L Bru*bac+ !linic", onl% about 2= o3 F56!" in the .-T#O. are co?a00licant arrange*ent" "uch a" the one bet<een Bru*bac+ an4 6!), an4 it i" not a *o4el that the% 0lan to i*0le*ent <i4el%2 #n *% o0inion, her in3erence <a" that the 7co?a00licant8 arrange*ent ha" been 0roble*atic2 The *o4el "ee*" 4e"tine4 3or 3ailure" a""ociate4 <ith the co*0eting intere"t" o3 t<o or *ore *a"ter"2 # a* beginning a "tu4% o3 the

0roble*" 0articularl% a""ociate4 <ith "i*ilar organi$ation" aroun4 the countr%, an4 0ro*i"e to relate *% 3in4ing" in the near 3uture2 22 Bru*bac+ BO) b%la<" "tate that the BO) "hall M-#.T-#. -. OFF#!& at 2,0 0th -(enue .orth, but the BO) 4oe" not *aintain an o33ice2 -n o33ice <ith a co*0lete "et o3 all !linic 4ocu*ent" i" e""ential 3or BO) *e*ber" to ha(e un3ettere4 acce"" to all Boar4 bu"ine""2 -t thi" ti*e, there are 3our ne< boar4 *e*ber", <ho "houl4 be 3a*iliari$ing the*"el(e" <ith all boar4 bu"ine""2 That i" <h% # reco**en4 that the Boar4 ta+e i**e4iate "te0" to buil4 out an o33ice en(iron*ent in "o*e location2 The a3ore*entione4 con"u*er co*0laint" relate to *% o<n e'0erience a" a clinic u"er an4 a 3or*er *e*ber o3 the boar4 o3 4irector", an4 # re:ue"t that the% be re(ie<e4, 0oint 3or 0oint, in con3or*ance <ith the !linic9" <ritten 0olic% regar4ing han4ling o3 co*0laint"2 # a* re:ue"ting <ritten re"0on"e" to each, in 4eliberate ti*e2 The ne't *eeting o3 the !L Bru*bac+ Pri*ar% !are !linic" BO) i" on Thur"4a%, October 24, 20 3 at 21 5 PM in the 6ealth !are )i"trict Boar4roo*, at1 2,0 0th -(enue .orth, Pal* /0ring", FL 334, On /atur4a%, .o(e*ber 2, 20 3, at 9130 -M, the Boar4 <ill con(ene 3or !L Bru*bac+ Pri*ar% !are !linic" /trategic Planning /e""ion, al"o in the 6ealth !are )i"trict Boar4roo*2 Thi" i" an i*0ortant Public Meeting, a" broa4 to0ic" <ill be co(ere4 relating to the boar49" (i"ion 3or the co*ing %ear2 # encourage all intere"te4 *e*ber" o3 go(ern*ent, the 0ublic, an4 the 0re"" to be there2 Re"0ect3ull%, W Michael Trout, !on"u*er cc1 cc1 cc1 cc1 cc1 cc1 cc1 cc1 cc1 cc1 cc1 cc1 cc1 cc1 Boar4 Me*ber", &'ec /ta33, an4 Practice Mgr", !L Bru*bac+ Pri*ar% !are !linic" Boar4 Me*ber", 6ealth !are )i"trict o3 Pal* Beach !ount% Boar4 o3 !ount% !o**i""ioner", Pal* Beach !ount% Boar4 o3 the Pal* Beach !ount% Me4ical /ociet% Boar4 o3 the Pal* Beach !ount% 6u*an Right" !ouncil Pal* Beach !ount% Hreen Part% Pal* Beach !ount% )e*ocratic Part% Pal* Beach !ount% Re0ublican Part% Pal* Beach !ount% #n4e0en4ent Part% Richar4 !or4ra%, )irector, !on"u*er Finance Protection Bureau -rlene Wal+er, 6R/- ProBect O33icer Mar% Wa+e3iel4, 6R/- -4*ini"trator, an4 Je% /ta33 /ecretar% o3 6ealth an4 6u*an /er(ice" Jathleen /ebeliu" Pre"" an4 Other"

For *ore in3or*ation, 0lea"e contact *e b% e*ail at <*ichaeltroutK%ahoo2co* To re(ie< the *inute" o3 the *eeting" o3 the !L Bru*bac+ Pri*ar% !are !linic" 0lea"e 4o<nloa4 the* 3ro* the 6ealth !are )i"trict <eb"ite 7botto* right corner o3 0age at htt01AAhc40bc2org81 Lune Meeting1 htt01AAhc40bc2orgAMo4ule"A/ho<)ocu*ent2a"0'M4ocu*enti4N2D9, Lul% Meeting1 htt01AAhc40bc2orgAMo4ule"A/ho<)ocu*ent2a"0'M4ocu*enti4N2DD4 -ugu"t Meeting1 htt01AAhc40bc2orgAMo4ule"A/ho<)ocu*ent2a"0'M4ocu*enti4N29 9 /e0te*ber Meeting1 htt01AAhc40bc2orgAMo4ule"A/ho<)ocu*ent2a"0'M4ocu*enti4N29,9 October Meeting1 htt01AAhc40bc2orgAMo4ule"A/ho<)ocu*ent2a"0'M4ocu*enti4N3000 /trategic Planning1 .ot Cet -(ailable -u4io 3ile" 7a" 0art o3 the 0ublic recor48 a(ailable on re:ue"t 3ro* !L Bru*bac+ &'ecuti(e O33ice"2 T6& M#..&/OT- -//O!#-T#O. OF !OMM>.#TC 6&-LT6 !&.T&R/ ha" a 0articularl% conci"e F56! in3o 0age at htt01AA*nachc2orgA3:hc2ht*l