Can the Coast Hospital District Board Fix the Adventists’ Problems?

Difficulty getting appointments and referrals that seems to be getting worse, according to public comments, and a healthcare survey of Mendocino Coast residents, and a long-delayed audit report for the fiscal year before last (the past year's audit is also late) were the main features of a Thursday night meeting of the Mendocino Coast Healthcare District Board of Directors on Oct. 28.

Unacceptable wait times for appointments and referrals were brought up repeatedly by members of the public during the meeting, which was far better attended than meetings in August and September, that were plagued by abrupt cancelations and other irregularities in public notice.

The session on Oct. 28 did get the required 72 hour public notice on the district's new website (https://mchcdorg.com) and had at least twice the attendance of recent sessions, with approximately 30 people tuning in via Zoom. Two of the five board members, though, Amy McColley and board secretary Sara Spring, were absent. Spring left September's meeting part way through without explanation. Board chair Jessica Grinberg, Treasurer John Redding and at-large member Norman de Vall were present last week.

At September's meeting, the district's new website had been suspended for non-payment, but by Oct. 28, the site was back up with a range of financial reports and meeting minutes, as well as the results of a district survey carried out by the board over the past few months.

The survey echoed comments by the public at last week's meeting expressing dismay over a lack of improvement in access to care since Adventist Health took over the hospital and clinic in July 2020.

“Significant frustration with timely access to care” first surfaced in the Focus Group meetings  and the survey confirms that half of the community is disappointed that access to care has not improved.

In answer to the question “Do you have timely access to health care providers, 51% said No and 45% said Yes (4% did not offer an opinion.)” the survey report stated.

The survey results also featured dozens of individual comments about care at the hospital and clinic, grouped into categories of “positive” and “negative” experiences. Though responses to questions asking to rate the hospital and clinic were mainly “excellent” or “good,” those asking for specifics included far more negative experiences than positive, with a large portion of the negative responses having to do with weeks of waiting for appointments and referrals, and more than a few noting rudeness or hostility from staff in what appears to be a fraught communications, referral and record keeping system.

The first few responses among the survey's “suggested improvements” are representative:

1. "Staff the phones. Receiving adequate, if not excellent, health care is important to patients and it starts with communication. If phone calls remain unanswered and are not returned, then no amount of literature or social media postings stating that Adventist cares and that the healthcare provided is excellent will make a person believe that. I also recommend training staff to refrain from telling patients that they are not to call, but to wait for a call to schedule a referral with a specialist…especially if that conversation is taking place several months after the referral date. A simple apology for the delay rather than a stern “don't call us…” would set a much better tone for working together if the goal is to provide good health care for patients. I voted for Adventist to come to our hospital and was eager for their arrival. My first Adventist experience was a simple but important matter and it was unsettling. I hope my experience with  the Adventist specialist next month is better than my experience trying to make the appointment and that the delay in getting in to see him has not compounded my problem.”

2. “Quicker response times."

3. “We need more Doctors and staff. I know housing is an issue. Maybe Adventist should check into at least some trailers for these staff members until they can find housing. Adventist needs to step up to the plate and fix this problem.”

Members of the public attending last week's meeting mentioned similar concerns, with one expressing “frustration and fear” when dealing with hospital and another stating “the situation is untenable for those needing medical care.”

Judy Leach, Adventist Health Mendocino Coast CEO, spoke at the Oct. 28 meeting, and acknowledged delays in recent weeks. She blamed a combination of staffing shortages at the hospital and clinic and a difficult changeover in computer systems.

Leach said the number of patient visits at the clinic has increased to 2224 over the last 12 months compared to 1846 in the 12 months previous. She said Adventist has contracted with a scheduling service to reduce wait times and has increased the number of providers, including recent additions of a new ENT specialist, a mental health provider and family practitioner.

“We thank you for your patience with us,” Leach told meeting attendants and the board.

Leach also said she was pleased that 20 applicants had attended a hospital job fair that day, although board member De Vall said he understood the hospital and clinic had 57 unfilled positions.

According to the survey's summary, 505 people responded, the vast majority from Fort Bragg. When broken down by size of community, Mendocino was the best represented, followed by Caspar and Albion, all with about eight per cent of households represented. Ninety three per cent of respondents identified themselves as Caucasian, with less than five per cent identifying as Hispanic, in an area with approximately 25 percent Hispanic population, according to census data. The survey was distributed online via local news outlets and Facebook pages. 

Though access to care was clearly on many people's minds, the bulk of last week's meeting was spent reviewing an audit of district finances for fiscal year 2020, with auditor Kami Matzek of Zarecor, Dingus and Associates noting several times that the information no longer applies since the board no longer runs the hospital, though it is charged with overseeing Adventist's overall performance on the public's behalf.

Matzek said the audit for 2021, the most recent fiscal year will also be late because of delays in the district providing financial information.

Board treasurer Redding acknowledged that it's time for the district to hire its own accountant and stop relying on Adventist Health for its financial services. While Adventist staff has been “fantastic,” he said, the district plans to hire a local accounting firm “soon.”

Lack of staff continues to dog the district board. Except for a brief period, the board has been without any staff since handing over management of the hospital in July 2020. The subject was not addressed last week, after contradictory votes in August on hiring local attorney Jacob Patterson, with the board ultimately deciding not to. As a result, board members are still doing all the work of organizing and publicizing meetings themselves. 

On the upside, auditor Malek reported she expects that most of about $5.8 million in COVID relief funds already sent by the Department of Health and Human Services to the district won't have to be returned. The district has been holding on to that money since, according to Malek, the reporting requirements required by the federal government have been in flux.

According to Treasurer Redding, even though the district never applied for any relief funds,  large amounts were deposited in district accounts by HHS “according to some algorithm,” eventually amounting to $5.8 million. Unsure if the district actually qualified for the money, the board spent none of it. Now, he said, it appears that the district can keep at least $4.4 million.

“That will go a long way toward building a new hospital, or whatever,” he said.

“We're kind of flush with cash right now,” he said, adding that at least $3 million in additional money for adjusted MediCal and MediCare payments has also just showed up in district bank accounts.

“They think we still own the hospital for some reason,” Redding said.

The next Mendocino Coast Healthcare District board of directors meeting is scheduled for Nov. 11. Meetings usually begin at 6 p.m. The agenda for the meeting should be posted by Nov. 8 at https://mchcdorg.com.