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The Crisis At The AV Health Center

The Philo Grange Building was standing room only last Wednesday evening, and the crowd was united in their support for the Anderson Valley Health Center’s embattled staff over the Center’s arbitrary administration.

Spiller’s Gotta Go, seemed to be the consensus view of the nearly 200 people on hand to bluntly express their outrage at the Health Center board’s decision to retain CEO Shannon Spiller but leave medical providers — Dr. Mark Apfel, Dr. Logan McGhan, nurse Cindy Arbanovella and psychologist Jessica McIninch — out in the cold.

Health Center Board Chair Ric Bonner sat at the front table with meeting organizers Heidi Knott-Gundling, Fred Martin, and Sheila Leighton, as serial locals urged Bonner and his board not to wreck the Valley’s only medical facility.

Most of the audience comments were refreshingly blunt as they castigated the Board for management and leadership failures, inevitably concluding with a demand that Health Center CEO Shannon Spiller be removed.

Shannon Spiller
Shannon Spiller

Ms. Spiller was hired as a Physician's Assistant two years ago, but was then appointed CEO in June of this year to replace Diane Agee, of the Gualala health center. Ms. Agee is one of the three persons from Gualala who had been overseeing the Boonville center for more than a year. Agee's team is apparently still functioning as “volunteer” consultants until February. Ms. Spiller is entirely the creation of Ms. Agee. In fact, AV Health Center staffers have told us that Spiller has referred to Ms. Agee has her “hero” on several occasions.

Dr. David Gorchoff, the now former CMO (that's chief medical officer) was hired in July and began work part time in July and August, presumably to help the Center comply with federal requirements, but fully assumed his position in September at 20-24 hours a week. He's gone, uncomfortable in the crucible he helped create.

When Bonner said that the board was trying to be “very prudent and cautious” by not taking any precipitous action, several audience members pointed out that the board hadn’t shown any prudence or caution when they let Ms. Spiller unceremoniously fire Dr. McGhan two Fridays ago. In fact, the board had gone immediately to the mattresses, retreating into the sphinx-like silence, their unique approach to problem-solving.

Each of the former medical staff members got standing ovations as they were introduced, as did retired nurse Judy Nelson and former Dental Clinic administrator Kathy Corrall, who was herself unceremoniously fired earlier this year when she was marched out of the Center like a criminal.

Ms. McIninch read a prepared statement which she said represented the views of the four providers (Apfel, McGhan, Arbanovella and McIninch) saying that the abrupt firing of Dr. McGhan was “simply unacceptable.” She said that when Ms. Spiller was a physician’s assistant at the Center they got along with her reasonably well as a co-worker, but her promotion to CEO was “wrong. She’s not qualified, experienced or communicative enough for the job, and she micromanages a lot.”

According to McIninch Ms. Spiller required the medical providers to waste at least an hour a day documenting everything they'd done. She tried to enforce a dress code — “in Anderson Valley?” added McIninch, as she stood next to Dr. Apfel, who looked like he’d just come in from doing some gardening. McIninch said that it took two years to find a doctor as qualified as McGhan, but then Spiller was hired and within two weeks “morale plummeted.”

“Shannon considered disagreements to be insubordination,” continued McIninch, which then led to Ms. Spiller issuing ultimatums to whomever she deemed insubordinate. Ms. Spiller also caused the resignation of well-regarded nurse Stephanie Long a few weeks earlier, added McIninch.

McIninch said that there were unnecessary payroll problems caused by Ms. Spiller’s hiring of Fabiola Cornejo who was “thrust into her new role” as “Chief Operating Officer” without the necessary experience or qualifications.

“We are willing to come back, but for us to come back it will require the removal of Ms. Spiller,” declared Ms. McIninch to a loud round of applause from the audience.

Dr. Logan McGhan
Dr. Logan McGhan

When Dr. McGhan was introduced, he described the current situation as “very stressful. But I’m overwhelmed that so many of you would come out to show your support. It’s way beyond my expectations.” McGhan then spoke a few words in highly polished and expressively fluent Spanish, specifically addressing the several dozen Mexicans standing in the back of the room, and removing any lingering doubt about his bilingual abilities. (The sociology of the Anderson Valley is faithfully represented at the rare public meetings attended by Hispanics, as it was at this one: Gringos, a small sea of righteous gray and shiny pates, were seated; Mexicans stood at the rear of the room. The AV Health Center's customer base is heavily Hispanic.)

Board chair Bonner explained that some of the board's decisions were forced by money and “federal requirements,” but that the Board wanted to bring staff back soon, adding that the Board was dealing with the “problem” with prudence and caution by interviewing everybody involved, a process they hoped to finish by last Friday.

Several people wanted to know what the timeline for dealing with “the problem” was. Bonner replied that it would be “soon” which he said meant “several weeks,” because “we have to deal with the short-term as well as the long-term,” adding, “It would be imprudent to remove Shannon without a replacement available.”

This statement from Bonner inspired low moans of disbelief followed by aggressive comments that “weeks” would be too long since the clinic is presently woefully understaffed.

When Fred Martin said that the Board should keep administration to a minimum and put medical staff first, there was another round of applause.

An older man neatly put the entire controversy into four succinct sentences: “We need better people on the board. You selected the CEO that everyone is unhappy with, and now you expect us to believe that this board can select the next CEO? That’s crazy. It’s a formula for disaster.”

Several people pointed out that no other board members, except newly appointed Claudia Jimenez, who was in the audience but not answering questions, were present.

Yorkville’s Jim Rutherford said, “I hear you talking about being cautious and looking at the long-term, but nobody looked at the long term when Logan McGhan was fired.”

Another round of applause.

A man seated behind me grumbled under his breath, “The short term is get rid of Spiller; the long term is after that.”

Beverly Elliott of Floodgate wondered why Ms. Spiller didn’t simply resign. “How could she want to continue under these circumstances?” asked Elliott. “She could resign and save us all the trouble and the clinic could go back to providing medical services.”

Several people suggested that the Board place Ms. Spiller on leave and re-install their estranged medical staff while they conducted their so-called “investigation. After all, as two locals noted, Ms. Spiller fired Dr. McGhan without checking with the Board first.

There was a lot of discussion about what leverage, if any, the community actually has given the insular, self-appointed nature of the board.

Heidi Knott suggested that a “concerned citizen committee” be formed, and that new board members be recruited. Others proposed that special subcommittees of the board be set up to address specific groups or problems. Several people thought that medical staff should be more involved in decision making. Formal personnel policies need to be put in place. What legal liability was the board incurring by firing McGhan? Was proper process followed? The Board needs to focus on patient care, not turning the Center into a “big business.” The Board needs to open up more, communicate with the Valley more, and be less secretive.

Eric Arbanovella, husband of nurse Cindy Arbanovella, said that the Health Center Board as it is set up is not accountable to the public. “It’s a closed unit,” said Arbanovella. “You need to change the bylaws so that the Board is accountable to the Valley.”

None of this advice seemed to faze Bonner who did not respond.

Board critic and eminence gris Gene Herr said that the public didn’t have any real power because the board makes their own rules and does only what they choose to do. They don’t even provide useful financial reports.

This reporter asked when the next board meeting would be, where it would be held, and what the agenda would be.

Bonner replied that it would be Tuesday, October 28 at 5:30pm in the conference room at the Health Center. Several audience members responded that the Health Center Conference room was way too small.

No response from Bonner.

Bonner said he hoped to have an agenda available by the weekend. (It wasn't.) But when people asked where the agenda would be posted, Bonner said he wasn’t sure — “the website hasn’t been working very well lately.” (And, as it turns out, Tuesday's board meeting is a closed session.)

Gene Herr pointed out that that’s because “Shannon Spiller fired Torrey Douglas and the webpage has become out of date. There have been zero communications from this board.”

After the meeting Torrey Douglas commented: “I do need to correct a few things, though. There have been updates on the site since July. Check under Announcements in the navigation. A couple months ago I met with Maxence Weyrich, the student rep on the board, and trained him to do the updates for AVHC moving forward, a wise cost cutting move for them, and not uncommon. Also, as of early summer I’ve been moving websites off my servers so that I can stop providing hosting. This does not mean I will providing web design and maintenance, but that I will no longer provide and be responsible for the site’s “parking place.” AVHC was one of the sites that needed to be moved, and they opted for a local web professional (whom I like and admire) who will provide both hosting and web maintenance once the site transitions to him. It’s understandable that they want one person to provide both services, which I no longer do. AVHC has treated me with respect and fairness in my dealings with them. Like you I’m unhappy to hear about the poor treatment of the staff, and hope the providers are reinstated soon. We need to put our energy there.”

Bonner somewhat laughingly suggested that it seemed like all he had to do was give the agenda to Gene Herr and it would get plenty of distribution, causing some giggles in the room, since Ms. Herr has become locally famous for sending out numerous and at times lengthy Health Center reports and emails to a long distribution list.

On the other hand, Bonner's smug dismissal of Ms. Herr with its implication that she, as lead critic, is somehow responsible for the crisis that he and his bumbling colleagues have created, is typical of the arrogance of this particular board.

As the meeting broke up, several people asked Dr. McGhan if he had plans to leave the Valley under these crummy circumstances and uncalled for treatment. McGhan promptly responded, “No. I’ve already bought my firewood.”

* * *

Gene Herr’s Update To The Mailing List last Thursday: “AVHC meetings re personnel crisis: I just sent a longer message which disappeared. FYI, Board will meet in closed session on Tuesday, at 5:30 to discuss personnel crisis. Probable community meeting Wednesday at 5:30 place TBA tomorrow. No word yet on Medical Staff decisions on any action. Write your opinions to the Board or show your support for medical staff at the clinic. More later.”

* * *

Another Mailing-List Comment: “Thanks to all for a good meeting. Thanks to Heidi for her clarity, diplomacy and strength, and thanks to the very civilized and intelligent audience! It makes me so proud to be a part of this community when we come together for something like this or the benefit for Charlie Paget Seekins and Mark Pitner. … As Ric said, nobody does news dissemination better than Gene Herr, but if they are to rely on her communication skills, the Board should be paying her.”

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