Coast Hospital Tries To Stop The Bleeding

by Malcolm Macdonald, September 7, 2016

Mendocino Coast District Hospital's Planning Committee met on August 16th in Fort Bragg. By meeting's end the six members of the committee, chaired by retired nurse Kitty Bruning, reached consensus on a priority ranking of strategic planning goals. The goals fall in to these categories: Financial Viability, with subtopics such as a potential parcel tax on property owners within the hospital district; a possible conversion to a “hospital fee structure” for the institution (which may or may not lead to millions of dollars more for the hospital per year); capital maintenance (this includes everything from the long delayed nurse call system repair/upgrade to sterilization improvements in the OR to $15 million or so of other short and long term maintenance repairs and upgrades); an Operational category, which includes the recently contentious issue surrounding the Obstetrics (OB) Department — it is budgeted for 2016-2017 — as well as subcategories like “Quality of care” and “Patient experience;” and a Community Relations category, which essentially boils down to the hospital positively marketing itself to the populace it serves. If credit is due for this list of priorities that credit goes to the hospital's Chief Executive Officer, Bob Edwards, and his leadership team. The final consensus list of planning goals is relatively similar to that proposed by Edwards.

Readers (along with some Planning Committee members) might wonder why “quality of care” and “patient experience” aren't the highest priorities for Mendocino Coast District Hospital (MCDH). The counterpoint would argue that without attention to the financial viability issues there will be no hospital for the patients to experience. A recent survey of California's hospitals gave MCDH a score of two in the category of overall patient experience (on a scale of one to five, one marking the low end and five the high). Almost anyone who has lived along the Mendocino Coast for any period of time can probably recount both positive and negative experiences at Mendocino Coast District Hospital. We all have favorite doctors and nurses. Some of us have had to endure less than adequate performances and behaviors by specific employees or providers associated with this hospital. I could recite my own positive experiences with the ophthalmologist Kevin Miller or recount recent cases involving hospital errors. Much of that is beside the point right now.

MCDH is one of the largest employers on the coast. It is the place private physicians and clinics refer patients to when health care matters get serious. Yes, if there is time to elect an alternative over the hill or in the Bay Area alternative, many folks take that option. I wouldn't begin to argue with them. However, if you have essentially taken MCDH for granted, that is tantamount to taking the mill in Fort Bragg for granted about fifteen years ago.

MCDH probably has three choices: 1) Grow itself out of its recent bankruptcy woes; 2) downsize, which would mean cutting certain departments (see recent articles on obstetrics department); 3) shut down entirely. That last option is not so far-fetched if one looks at the number of hospitals that survive bankruptcy. Note that just muddling along doing things in roughly the same way they have been done for the last few decades is not an option.

The current administration may have their priorities straight for MCDH, but they have also shown an ability to proverbially shoot themselves in the foot then try to tie a pretty ribbon around the wound. Case in point: Readers may have noticed something advertised as “Immediate Care” at North Coast Family Health Center (NCFHC), the hospital affiliated clinic. There's even a big banner to that effect over the front doors. The reason there is “Immediate Care” at NCFHC is that this program is a repackaging of a “Fast Track” plan for the Emergency Room (ER) at MCDH itself. It is being repackaged (perhaps NCFHC would have been a more appropriate starting point) after the ER Fast Track essentially failed in its first few months due to poor planning and implementation.

Of course, smaller, rural hospitals like MCDH have their hands tied by federal regulations and reimbursement, particularly the lack of the latter. Small hospitals and their clientele will continue to struggle, at best, for adequate care and compensation until we adopt something very, very close to universal health care.

Financial viability is the bottom line for MCDH, but how much money comes in will decidedly depend on the word of mouth brought about by individual patient experiences. Those need to become more consistently positive for this hospital to pay its bills let alone grow into the future.

Here's a little known, outside of hospital insiders, money factoid: Along with all those repairs and upgrades ($15, $16, or $17 million worth) and the legally required new facility in thirteen years, MCDH has been limping along with hybridized, jury-rigged Electronic Health Records (EHR) for several years. The hospital has been granted waivers for its out-of-date system due to the recent period of bankruptcy. Those waivers are coming to a close and if deadlines are not met MCDH will face heavy monetary fines for its faulty EHR system. The best ballpark guess for an up-to-date EHR replacement system: $2.5 million.

When this writer first started covering MCDH in earnest about two years ago the Hospital Foundation, main fundraiser for MCDH, stated on its website that it was proud of raising about seven or eight million dollars for the hospital, total. Seven to eight million dollars in approximately 30 years. That doesn't cut it. If the so-called Hospital Foundation can't up that ante significantly it should be disbanded and the MCDH Board of Directors should look elsewhere for money raising assistance that can make an actual difference. Don't get me started on how the Hospital Foundation's main attempt at fund raising is essentially a wine and booze event for the semi-wealthy who obviously are drinking too much and donating too little.

The public will get their most straightforward input this November when three MCDH Board of Directors seats are up for election. Two years remain for the seat recently vacated by the resignation of Kate Rohr. Three candidates have announced for this seat: Tanya Smart, a community college instructor and spouse of the lone obstetrician left on the coast; Dr. Kevin Miller, an ophthalmologist with NCFHC; and Patricia Jauregui-Darland, registered nurse and current Vice-President of the Hospital Foundation. Running for the two four year seats on the MCDH Board are current Board President Tom Birdsell; Steve Lund, interim appointee replacing Dr. Rohr and recent past President of the Hospital Foundation; Dr. Lucas Campos, physician; and Kaye Handley, a retired investment manager and current member of the MCDH Planning Committee.

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