by Malcolm Macdonald, June 28, 2017
But Ob-Gyn Saved, For Now...
By a 5-0 vote the Board of Directors of the Mendocino Coast District Hospital (MCDH) has decided to keep the obstetrics (OB) department open for the next three years. The vote was taken before a standing room only crowd in Fort Bragg's Town Hall on June 22nd. The vote was amended twice, first by Dr. Peter Glusker, to guarantee OB remain for at least three years. This has been a bargaining issue between Mendocino Coast Clinics (MCC) and the hospital. MCC has pushed for the three year guarantee from the Board and administration in return for MCC recruiting additional OB doctors to the coast. The Glusker amendment looked good to go for approval as Board members Dr. Lucas Campos and Kitty Bruning renewed their motions in favor, but MCDH Board Chair Steve Lund added phraseology to the effect of, “as long as is financially viable,” essentially undercutting the three year guarantee.
Before the vote the MCDH Board listened to a unanimously voiced community give impassioned reasons for keeping the OB Department open. Dr. Glusker was the only board member who seemed prepared to speak to the issue without reluctance. His statement captures, or alludes to, much of the problem as a whole, “The administration’s proposal to close OB is a very bad idea. Our geographic location makes the availability of OB care just as critical as the emergency room or surgical care. There are careful studies showing increased maternal and infant morbidity and mortality, as well as decreased economic performance in hospitals that close OB...
“It would be medically, ethically and economically extremely irresponsible to close OB, in my opinion. It is also inappropriate in my opinion to make OB an economic scapegoat for the hospital's economic condition. Our economics continue to be very critical, not only related to OB, but to a variety of complex local factors including excessive Registry personnel throughout the hospital (replacing many nurses who train here but leave because of unpleasant workplace conditions), unusually and inordinately high employee union benefits, perpetual guaranteed income for independent contractors, and excessive debt load. There are also national economic factors affecting small rural hospitals.
“OB is critical to the survival of the District for medical, ethical and economic reasons. Closing OB would be more than suicidal. A parcel tax is also critical to the survival of the District, but is not adequate by itself. We need better administration with a more transparent analysis of all departments of the hospital, including the release of financial information which to date remains unavailable. We need better working conditions so that nurses will stay instead of moving to Lake and Marin counties and the bay area. We need a balanced budget, not one that continues to keep us in debt. Finally, we need a long term financial plan for the replacement and/or repair of our seismically deficient physical plant.”
It was Chief Executive Officer Bob Edwards who initially ran out the idea to close OB almost a year and a half ago at a hospital committee meeting. Much recent blame was thrust upon board member Dr. Kevin Miller for chairing a committee looking into the viability of the OB Department and for apparently insisting on an up or down OB vote being placed on the MCDH Board of Directors' agenda. Dr. Miller has appeared to be “carrying the water” for CEO Edwards on the OB issue. In fact the first words out of Miller's mouth at the June 22nd meeting were, “A vote of confidence to our administration.”
Miller and Campos are new to the area. That newness probably seemed appealing to voters in last November's election, many of whom were no doubt tired of the same old, same old leadership on the MCDH Board, leadership that had taken the hospital into a bankruptcy that lasted from October, 2012 through to the spring of 2015. Unfortunately, as newbies at the hospital Miller and Campos appear to be heavily influenced by the leaders they see and speak with most often, Chief Executive Officer (CEO) Bob Edwards and Chief Financial Officer (CFO) Wade Sturgeon.
The clear and present problem is that Edwards and Sturgeon are not the kind of people you want to listen to, not unless you want to be perpetually misled. Along with making the OB Department a scapegoat for the hospital's economic woes, let us count the ways these two have led the hospital, its employees, and the taxpayers astray.
In the fall of 2016 Mendocino Coast District Hospital's Chief Financial Officer (Sturgeon) downplayed the seriousness of billing and coding errors made by the newly contracted Emergency Room (ER) provider (EmCare) in official report after report to the hospital's Board of Directors and its Finance Committee. In addition, both the CFO and CEO Edwards ignored internal warnings to add employees to sort out the billing and coding mess.
That information dates from a March 8th AVA article ("Coast Hospital: Déjà Vu Again"). More details can be re-read from a March 1, 2017 AVA piece as well ("Coast Hospital Falls Behind"). No one from, the CEO or CFO to the MCDH Board, has ever denied this. They just go blithely along, hoping the public in general will not notice.
Fourth quarter (Oct.-Dec.) 2016 professional fees, from Medicare, were not paid to two North Coast Family Health Center (NCFHC) physicians in anything resembling a timely fashion. Reports are that this was an ongoing problem as of mid-March, 2017. The CFO did not report this problem in anything resembling a timely fashion to the Board or the Finance Committee of MCDH.
Let us go on: Rural Health Clinic (RHC) claims from NCFHC, approximately fifty days worth, dating from mid-November, 2016, into Jan., 2017, were not billed for at least as late as mid-March.
That's from a March 22nd AVA article ("Ongoing Trouble at Coast Hospital"). Also from that article: In the autumn of 2016, NextGen (a provider of electronic health record sytems) refused to release updated ICD-10 codes to the hospital, alleging that MCDH had not sent out its invoice to NextGen. CFO Sturgeon did not report this to the board or the finance committee in any sort of timely manner. Quite the opposite. At a Jan. 4, 2017 Finance Committee meeting Mr. Sturgeon stated that issues associated with the clinic's (NCFHC) billing had been fixed or would be fixed by the end of January. Yet the issue of professional fees cited above still existed at least two and a half months later. There has been no denial or refutation of these points either. Yet Board members like Campos and Miller still support their administrators.
Then there is the issue of workplace harassment. Late in 2016, MCDH's Chief Human Resources Officer Ellen Hardin filed a harassment complaint against Sturgeon. Hardin was placed on administrative leave, which, in and of itself, seems strange, since natural inclination would say the accused would be the one placed on leave, pending investigation.
Keep in mind Hardin's harassment claim may have included CEO Edwards as well. Another employee who had filed her own harassment charges againt both Edwards and Sturgeon, later felt the need to file additional harassment charges against Board Chair Lund and Board member Miller for behavior aimed at intimidating the employee into dropping her original charges against the CFO and CEO. By the time that employee attempted to file paperwork associated with the harassment of Lund and Miller, Hardin's chief assistant in the Human Resources Department at MCDH had been fired by Edwards. The reason: Edwards suspected Hardin's assistant of leaking information about the Hardin case. Full disclosure time: Hardin's assistant didn't leak anything to this writer (I wouldn't know her if I bumped into her on the street) and to the best of my research and knowledge Hardin's assistant did no such thing with anyone else in the world of the press.
By this spring paranoia had set in with CEO Edwards, not only had he fired Hardin's assistant, but he moved out of the traditional CEO office because the room was not sound proof enough for his liking. His new office is in an extreme corner of the hospital building, with no name plate on the door, nothing to indicate who resides therein.
Back to that hospital employee with harassment charges to file against board chair Lund and board member Miller. Without Hardin or her chief assistant around, the next person down the totem pole in Human Resources appeared to not know what to do with harassment paperwork aimed at two board members, so who did that HR person go to for direction?
Sit down and buckle in, it's going to be hard to swallow this, but it was Wade Sturgeon. Apparently CFO Sturgeon has some background in HR as well, so (Holy Orwellian Truths!) he was/is apparently handling much of the decision-making, even in the most sensitive human resources matters at the hospital. Two different individuals, familiar with the inner workings at MCDH have, separately, verified this.
From the beginning of Ellen Hardin's harassment charges against Sturgeon, CEO Edwards has supported his CFO every step of the way. Remember it was Hardin who was placed on leave, not the accused harasser, Sturgeon. When information about some of this got into the press (chiefly at the AVA) Edwards fired Hardin's main assistant. The long time Quality Risk Manager, who questioned Edwards and Sturgeon's ethics while siding with Hardin left for a job in the Bay Area or she most likely would have been fired. At some point Edwards learned that the Chief of Patient Care Services, Terry Murphy, was friendly with Hardin, so Murphy was the next to be placed on administrative leave by the CEO, pending an investigation. “Pending an investigation,” were Edwards's exact words. Keep that concept in mind.
Meanwhile, under the pretext of a performance review of Sturgeon, the MCDH Board, with Lund doing the speaking at the conclusion of a March 16th closed sesssion, told the two or three members of the public present that the board would be conducting further interviews with hospital staff before rendering a final judgment concerning the CFO. Put simply, there were no further interviews conducted.
On June 13th, the board held another closed session on Sturgeon's performance. After about forty minutes, Lund read a prepared vote of confidence statement regarding Sturgeon. The most obvious question regarding that closed session, if there was supposed to be more discussion about Sturgeon's work before an up or down vote on his continuation as CFO, why did Lund read his confirmation of Sturgeon's job performance from a paper prepared ahead of the start of the closed session?
Additionally, Lund's statement included, “After careful deliberation of this matter, including a thorough, confidential investigation conducted by an outside, independent law firm...” The outside investigation was concluded early in 2017, yet there were performance review hearings concerning Sturgeon that continued into March as well as the June 13th meeting. How could the investigation be categorized as “thorough” if further meetings were needed months later?
Another problem: Lund's statement claimed that this early 2017 investigation was thoroughly independent. However, the law firm alluded to in his statement was completely paid for by MCDH. No law firm nor investigators hired by Ms. Hardin were consulted by the MCDH Board.
Much of Sturgeon's performance review was predicated on the investigation into harassment charges made by Ellen Hardin. However a letter was sent by CEO Edwards to Ms. Hardin just two days after the March 16th closed session performance review. The letter essentially asked Hardin to sign off on an employment termination. This just two days after the hospital board promised further interviews regarding Sturgeon's performance. In plain language the majority of the hospital board promised one thing then the CEO completely undermined that promise two days later. The majority of the board has done nothing to control, let alone rebuke, Edwards's actions. Dr. Glusker remains the only exception to the MCDH Board's blind ethical eye.
On June 14th, one day after the MCDH Board of Directors voted four to one (Glusker dissenting) to retain Sturgeon in his CFO position, Edwards fired Chief of Patient Services, Terry Murphy.
Ms. Hardin, her assistant, the Quality Risk Manager, Ms. Murphy, and at least one other woman have been fired directly or forced from their jobs in the last six months by Edwards. One has to wonder if this particular CEO has a problem with assertive women professionals?
Bottom line: It certainly appears that unethical administrators are running MCDH, with a majority of its board of directors either complicit in covering up a variety of disreputable actions or too blinded by some sort of misplaced sense of loyalty to take proper action.
For months this writer has asked, in front of the MCDH Board, questions that have not only gone unanswered, but have simply been ignored even when submitted to them in writing. Questions as simple as the cost of hiring the law firm to investigate in the Hardin-Sturgeon harassment case. There's a litany of more troubling questions that readers can peruse past articles for.
Currently, CFO Sturgeon failed to notify the board or the finance committee about Medi-Cal Reconciliation payments that the hospital will have to make to the tune of $75,000 per month for more than two years. Sturgeon would have been notified about this in the last month of 2015. He didn't inform the hospital board or its finance committee about the situation until this June, 2017. These payments are in regard to Medi-Cal billing in 2013 and 2015. Sturgeon still has not notified the hospital board or its finance committee concerning payments due back to Medi-Cal for 2014 and 2016. Those amounts are approximately $550,000 and $375,000.
There are even more serious financial questions regarding Sturgeon's actions or inactions as CFO, but we'll leave those details for a later piece. One has to wonder what it will take to open the eyes of some of the current MCDH Board of Directors?
In some ways the uproar about the OB Department has provided a smokescreen for the shenanigans of Edwards and Sturgeon. In that light we'll conclude with the words of retired board member, Dr. Kathryn Rohr, who apparently is still watching closely:
“When will they listen?
“It was inspiring to watch the community’s enthusiastic support for the obstetrical service at our hospital. It was gut wrenching to watch the District Board remain brain dead in response. How many times must so many speakers so eloquently express the reasons why obstetrics is a critical service in a remote rural hospital only to watch the Board pass a resolution that in reality accomplishes nothing? A last minute modification of a straightforward motion by Board President Lund reduced the evening’s effort to ashes.
“Who continues to put this matter on the agenda? Who continues to expend resources proving why they CAN’T save the department instead of making a decent effort to determine how they CAN save it. We live in a republic where we expect our elected representatives to respond to the desires of the electorate. When those representatives refuse to listen, there is a process to replace them. It should be abundantly clear that the only true solution is to RECALL those members of the Board who refuse to listen to our community. Until we have a Board dedicated to removing a feckless, incompetent administration and providing the needed services, no amount of taxes will solve the current problems. Until then it will be like giving another bottle of booze to an unreformed alcoholic and telling him to use it wisely.”
As this piece was about to be submitted word arrived that another department manager at the hospital has left MCDH after accusing Edwards and Sturgeon of harassment. Whether the harassment charge was made in a formal complaint is not known at this point. A person familiar with the situation at the hospital described the departed as, “A very good manager.” Another individual with long time experience at MCDH stated, “[This manager] was a huge victim of Wade [Sturgeon]. [The] emails Wade sends are Nasty!”