Reprieve For Dr. Harris

The headline  from the August 17^th Mendocino Coast District Hospital's special Board of Director's meeting: The MCDH Board voted to grant Dr. Diane Harris a ninety day extension to negotiate a new contract for her continued physician services at North Coast Family Health Center (NCFHC), the hospital affiliated clinic in Fort Bragg.

The agreement did not come about until enough “failure to communicate” kerfuffles to land Cool Hand Luke a month's worth of “night in the box” punishments (To anyone beyond the age of twelve who fails to understand a Cool Hand Luke reference may I suggest an immediate viewing of the 1967 film classic – culturally and educationally it is more important than tomorrow's homework).

A month's worth of kerfuffles is precisely what's been going on at Mendocino Coast Hospital, at least at the administrative level. There are some fine people laboring in the trenches at MCDH, from doctors and nurses on down the pay scale. Unfortunately, for at least a half decade if not longer, the Chief Executive Officers (CEOs) at MCDH have not been keeping close tabs on their physicians contracts and the Boards of Directors have not been following through in keeping close tabs on their CEOS. This leads to all sorts of problems, not the least of which are billing oversights and exposure to Stark Law violations (See my June 3^rd article for an explanation of Stark Law – Thankfully not all knowledge is gained through the cinema; you don't have to watch the Tony Stark character in Iron Man to grasp the fundamentals of the Stark Law.). MCDH is still in the process of paying off about $200,000 in federal Stark violation penalties, another $200,000 or so having already been paid while MCDH was coming out of bankruptcy.

Into this climate of uncertain physician contracts marched one Bob Edwards, the newly hired hospital CEO at a salary of $320,000 annually plus benefits. Keep in mind that the city manager for the entire municipality of Fort Bragg, CA makes only slightly more than half of what MCDH is paying Edwards. At some point after he was hired this spring (exactly when is a nebulous truth to get at) Edwards discovered that four of North Coast Family Health Center's long time doctors' contracts were about to run out. On what was obviously very short notice the four physicians were asked to re-up. Dr. Jason Kirkman did so. Apparently, Drs. John Cottle and Jennifer Kreger had reservations about the contracts proffered to them by Edwards. They both asked for two month extensions to their existing contracts to consider the new contract and continue negotiations about said same contract. In a hastily called, special Board of Directors meeting in July, (Dr. Bill Rohr, MCDH Board member, described being told at 1:30 or 2 pm that a meeting was occurring later that afternoon) the MCDH Board of Directors approved the negotiation extensions for Drs. Kreger and Cottle.   Left out in the cold was Dr. Diane Harris, the fourth North Coast Family Health physician with an expiring contract. Harris claimed that Edwards had told her four days before her old contract expired that she needed to 'suck it up' and sign the new contract. A contract a pair of her colleagues had already questioned enough to ask for two months of extended negotiations.

In a public statement concerning the contract problem, Harris stated, “Two days before the end of the contract with three doctors unwilling to sign the new contract... I requested to see the latest version of the contract and Ilona Horton (NCFHC administrator) refused to give it to me saying that she and Bob Edwards decided to let my contract expire, and that they weren't going to negotiate with me any more. The next day I found out that the MCDH Board met in emergency session and gave the two other doctors who also wouldn't sign the contract a 60 day extension on their contract for further negotiations. I asked the Chair of the Board [Sean Hogan] to schedule a special meeting to extend my contract in the same manner. My request was declined.

“The administration didn't consider the effects of their actions on my patients, myself and my family, and on the community. Patients have had multiple reactions to the news of disruption of continuity of THEIR care. They like me and are very supportive of me. But they are flummoxed, furious and frustrated, deeply distressed and disoriented. They have said the following: The lack of consideration for the patients is immoral. What is glaringly absent is a focus or concern for the sacrosanct relationship between doctor and patient, and the healing process. I have found Dr. Harris to be knowledgeable, agreeable, and helpful. Clearly she is smart and patient-centric. I have valued my sessions with her and feel she is one of the best doctors in the area. It is incomprehensible that the administration would allow this to happen.”

At the August 17^th special board meeting an assortment of Dr. Harris' patients filled the board room, many rose to praise Dr. Harris's manner and method of medical practice and to express their displeasure at the abrupt nature of her termination as well as dismay about lies told to them concerning Dr. Harris' absence by North Coast Family Health officials. MCDH Board Chair Sean Hogan said there was nothing to be done at this particular meeting because Dr. Harris' matter was not on the agenda.

Indeed it was not, but newly elected (last fall) Board member, Dr. Peter Glusker spoke up to make an emergency motion that the matter be discussed. After what appeared to be defensive maneuvers by John J. Ruprecht, the MCDH Board's local attorney, Dr. Bill Rohr seconded Glusker's motion. Hogan and fellow Board member Kitty Bruning (along with Glusker and Rohr, newly elected in November, 2014) voted 4-0 to continue discussing the Harris matter (fifth Board member Tom Birdsell was absent).

Almost as soon as discussion ensued, Dr. Glusker motioned that Dr. Harris be granted a similar extension period to that offered to Drs. Kreger and Cottle. Again Ruprecht proved reticent to move forward with anything so novel. He halted discussion several times under the pretext that he was trying to protect the hospital from potential litigation and further Stark Law violations, but from this vantage point it appeared that Ruprecht was doing all he could to stop Glusker's motion and block the extension of Harris' contract.

While this was ongoing one couldn't help notice interim Chief Financial Officer Steve Miller leaving the room. Miller, who has been on duty during the period that MCDH extricated itself from bankruptcy, is about to finish his term of office and return to his home in Texas. He didn't need to do anything extraordinary, but he did nonetheless. While out of the board room, Miller called an attorney at Ober Kaler, the national legal firm representing MCDH. When Miller returned to the meeting he reassured the Board that MCDH could extend Dr. Harris' previous contract for as much as six months without any fear of Stark Law violations.

Miller's quick maneuver not only paved the way for Glusker's motion to go forward, but undermined attorney Ruprecht's repeated delay tactics. One might say it also demonstrated his lack of legal knowledge on the same topic he made a point of bringing up.

Roll call on Glusker's motion went forward, with an amendment that she be given a ninety day extension dating from August 1^st to make up for the time lost in potential negotiations. Glusker and Rohr voted to approve the negotition extension for Dr. Harris. After a moment's hesitation, Kitty Bruning abstained. Board Chair Sean Hogan, a retired attorney, at first abstained also, then changed his mind and announced that he was recusing himself from the vote. The recusal came with little discernible explanation. So, by a 2-0 vote Dr. Harris was granted a contract negotiation extension similar to Drs. Kreger and Cottle.

A closing note: at the August 17^th meeting, new CEO Bob Edwards denied telling Harris to “suck it up” and sign the new contract. Immediately thereafter several members of the public could be heard voicing their disbelief in Edwards' words.

* * *

The August 10, 2015 Fort Bragg City Council meeting offered plenty within its agenda to pique the interest of the citizenry. Unfortunately less than ten showed up, fewer than a handful stayed for most of the subject matter, including the adoption of a resolution declaring a Stage 1 water emergency for the town. With so little tangible interest paid to the civic matters at hand, it seemed somewhat ironic that Councilman Lindy Peters proposed that city staff provide a report giving direction as to how the council might go about putting the concept of excluding social services from Fort Bragg's central business district on the ballot in California's June, 2016 primary election. A drive to gather enough valid signatures for just such an exclusionary  initiative recently fell one signature short of qualifying for a yea or nay ballot vote.

There were only two brief public comments concerning this proposed initiative to ban social services from the downtown business district, Rex Gressett in favor and Scott Menzies vehemently opposed. Both left the premises relatively soon thereafter. The audience quickly dwindled to two members of Mayor Turner's family, lifelong Fort Bragg resident Jay McMartin-Rosenquist, and yours truly. While Ms. McMartin-Rosenquist remained silent at the City Council gathering, she did offer her opinion online some time later: "Did you hear Scott's [Menzies] comments re the initiative. He is a new comer. They use to run them all out of town. I was born and raised here and so were many. Support the locals who built this town and enjoyit as yu decided to live here but I am tired of others telling us what to do and how to act. Go home to where you came from and tell your home town folks how to walk , talk and behave. Sorry my rant for the night."

Just how definitively Ms. McMartin-Rosenquist's words reflect others who are signatories to the potential initiative barring social services from the downtown area of Mendocino County's second largest municipality remains to be seen. On the Facebook page where her remarks appeared the next comment was, "yeah... new guy with personal ties to the old coast project via thai chi classes called all of us bigots...."

Joe Wagner, who offered the preceding comment had earlier offered his thoughts on why so few locals are attending recent council meetings, "Many people feel really shut down by the city. i talk to many in this group and i keep hearing i'm done with those stupid meetings.... they don't listen to anything the public has to say..."

Those fixated, yea or nay, on the possibility of privatized mental health services being offered up at the Old Coast Hotel site on the corner of Oak and Franklin Streets are missing out on a story that has slithered through the weeds in Fort Bragg for years now. That story centers around the financial woes of the Mendocino Coast District Hospital (MCDH).

There was some consternation a month ago about the raise, approved by the city council, given to Fort Bragg's City Manager, Linda Ruffing. Most reliable sources report that said raise was actually below the statewide COLA (cost of living average). While Ruffing's annual pay is in the $150,000 - $180,000 range, the new Chief Executive Officer (CEO) at Mendocino Coast District Hospital (MCDH), Bob Edwards, is being paid $320,000 yearly, plus benefits.

MCDH board meetings are primarily attended by hospital staff, with extremely little participation from the general public.  Many readers will need a little backstory: MCDH, though it theoretically came out of bankruptcy earlier this year is still operating, month to month, just above and sometimes below the break even point. Unexpected costs have a way of continually popping up for the administration of this outfit.

In a similar vein, the deadline for negotiating with the hospital's union employees came and went at the end of June without action from the hospital's board or new CEO Edwards. It took a full month longer for the hospital board and/or CEO to come up with a proposal for the employee's union. As we write and read union members are voting on that proposal by mail-in ballots. Results will be announced on August 20th.

An item that would have appeared run-of-the-mill ordinary, negotiations for new contracts for four mainstay physicians at North Coast Family Health Center (NCFHC), the hospital affiliated clinic just across the parking lot from MCDH, has turned into a brouhaha.

The four physicians in question at NCFHC are Jason Kirkman, John Cottle, Jennifer Kreger, and Diane Harris. According to sources fairly close to the situation the four physicians were offered "take it or leave it" contracts that did not include the usually standard malpractice tail coverage. Tail coverage provides insurance for a doctor for several years following their tenure at a medical facility, protection for after the fact lawsuits alleging malpractice. Leaving such a basic clause out of a contract offer could be viewed as a professional slap in the face.

Apparently, Dr. Kirkman signed the proposed new contract, reportedly with some sort of statement indicating, 'Heck, contracts don't mean all that much around here.' Indeed, the lack of properly signed contracts has cost MCDH muy dinero in billing dollars during the last two administrations.

Drs. Cottle and Kreger were the subject of an emergency MCDH board of directors meeting on July 30th. The focus of the meeting: a two month extension in the negotiating process between MCDH and Drs. Kreger and Cottle.

This leads us to the August 11th Fort Bragg City Council meeting. In the agenda section entitled, "Matters From Councilmembers" Councilman Doug Hammerstrom, who is the husband of Dr. Diane Harris, made the following statement: "North Coast Family Health Center [NCFHC] has been putting out a great deal of misinformation. Some of you patients have contacted Diane, worried about her because of the information you were hearing, worried about North Coast Family Health terminating Diane's contract.

“First, it is not true, as patients have been told, that she has taken a medical leave. She does not have a medical issue. You do not need to worry about her health. Patients have also called because the information they've been told makes no sense and they think there must be some other story, and worried that Diane has some unknown problem. Diane is not having some unspeakable problem.

“The reason you are being misinformed is a smoke screen by North Coast Family Health Center. They do not want to tell you the truth that two days before the end of her contract term, they [NCFHC] informed her they would no longer negotiate the renewal of her contract. The next day at a [Mendocino Coast District Hospital - MCDH] board meeting two other [NCFHC] doctors had their contract terms extended two months to continue negotiating renewal of their contract terms.

“Diane asked the [MCDH]board to take the same action on her negotiations, but that request was declined. Diane would not have terminated her relationship with her patients in this sudden way. The suddenness is a result of being involuntarily terminated by North Coast Family Health Center.

“Diane loves being a doctor. She enjoys her relationship with her patients, some of those relationships are twenty-three years in duration. She feels a responsibility to her patients, and feels at this time that she is letting them down. She is seeking to find another situation in this community where she can continue her relationships with her patients.

“If you are concerned about her treatment you can write a letter to the [MCDH] board. There is a board meeting on Thursday, August 20^{th [actually Aug. 27th]}, at 6 p.m., in the Redwoods Room [of MCDH]. You could attend and speak to the issue at that meeting, perhaps on non-agenda items, perhaps there might be an agenda item that might involve it.

“On her behalf I wanted to take this opportunity that I have to speak to the community to attempt to get the word out to at least some of her patients who my have heard the same worrying information that has caused people to call her with these worries.”

This writer called Mendocino Coast District Hospital CEO Bob Edwards on August 11th in an attempt to garner his side of the story. An assistant answered the phone and said she would try to get Edwards to return the call later on the 11th or the morning of August 12th.

I also called Ilona Horton, the adminstrator for North Coast Family Health. She sounded somewhat startled to hear that I was in the midst of writing a piece about the contract offers to the four NCFHC physicians. She stated that she would have to consult with a public relations person before making any comment.  About a half hour later Horton called back to say that "we" will be sending an email response within a couple of hours. Half of the following day came and went without the promised email. Follow up calls to Ilona Horton's office produced only voicemail. I left a reminder message that no email had been forthcoming, including a slowly spelled out repetition of the email address and my phone number. An hour later I called Bob Edwards' office. The assistant answered again. Her response was that their PR guy, Sid Garza, was supposed to have already sent me said email. Fifteen or twenty minutes later the CEO's assistant called back to say "they" were working on an email response and that I should receive it within a few minutes.

Is there anything in this list of obfuscations that would make readers believe the powers that be at MCDH and North Coast Family Health over Dr. Harris or her husband's comments at the City Council meeting?

How was the decision to decline a contract renewal to Dr. Harris made by the hospital? The closest thing to clear evidence lies in the July 16th MCDH Board of Directors agenda and minutes. Under "Action" items:  Mr. Hogan [Board Chairman Sean Hogan] would like to appoint two Board members to review physician contracts with Bob Edwards; they can make a presentation to the Board and suggest the Board either accept or reject the contracts without the Board having to hear all the details of the contracts.  Discussion ensued. Mr. Hogan appointed Dr. Glusker and Tom Birdsell to the Physician Contract Review Ad Hoc Committee.

This implies Edwards was in charge of making the contract offers to NCFHC physicians Kirkman, Kreger, Cottle, and Harris. How much input Dr. Glusker and Mr. Birdsell had in the makeup of said contract offers remains to be seen. How much needs to be read into the phrase "without the Board having to hear all the details of the contracts" is still open to interpretation.

Finally, the promised email arrived in my inbox, signed by a Sid Garza-Hillman. Beneath his name are the descriptive terms: Writer. Podcaster. Speaker. Health Coach.

Here is the email response Mr. Garza-Hillman offered up, with the heading, Mendocino Coast District Hospital  August 12, 2015: ""Regarding the recent physician contract renewal, MCDH believes the most responsible course of action is to present the facts as documented in the Hospital Board meeting minutes in hopes of minimizing misperceptions and false rumors. Four primary care physician contracts were due for renewal by July 31, 2015. A boilerplate agreement was presented to the hospital board on May 28, at which time the Board requested additional information. On June 25, the Board approved the agreement. Following the Board approval, the four physicians acted in the following ways. One physician signed the new agreement on July 31. One physician did not wish to sign the agreement, thus allowing her existing contract to expire on July 31. Two physicians signed extensions to the agreement, wishing to continue their work while receiving more time to review the new agreement. We ask that the public contact the hospital directly with any concerns or questions they may have about the conflicting reports currently surfacing in local media."

A glaring miscalculation in chronology exists in this email: The email claims that MCDH's Board of Directors had the finalized physician contract proposal on June 25th, yet this same board made no effort to put together a physicians' contract review team until the July 16th meeting. What kind of board waits until two weeks before contracts are up to start to put together a contract review team?

The email claims that one physician (Dr. Harris) did not wish to sign the contract agreement. This flies in the face of the public testimony of Dr. Harris' spouse, ten year city councilman Doug Hammerstrom, as well as the words of Dr. Diane Harris herself who has publicly stated that the contract was offered up for her signature without the opportunity to fully read it first. Dr. Harris further stated that when she asked for the same treatment as Drs. Cottle and Kreger, a two month extension in negotitaions, she was flatly denied that opportunity. The MCDH's PR man's email disingenuously omits the short notice, the lack of tail coverage, as well as Dr. Harris' request to be treated in the same manner as her colleagues, Drs. Cottle and Kreger.

Mr. Garza-Hillman offered the quotation marks in the email on behalf of MCDH. Precisely which individual in a position of authority is being quoted remains distinctly obscure. And this is a huge part of the point regarding MCDH currently. Note the closing line, "We ask that the public contact the hospital directly with any concerns or questions they may have about the conflicting reports currently surfacing in local media."

Well, this member of the public, who pays taxes that help support MCDH, called and asked for either the CEO of the hospital or the administrator in charge of North Coast Family Health to explain what's going on and their response was to hide behind a PR guy's tardy and feeble response.

Editor’s Postscript

The following was frantically circulated prior to the board meeting:

The MCDH board only has the authority to approve or reject doctors' contracts as they are presented to them. They do not create these contracts. MCDH administration is supposed to maintain a calendar of contracts. For whatever reason, the calendar of contracts was "missing," and three doctors' contracts were set to expire in one day. Bob Edwards, CEO, asked for an emergency meeting of the hospital board and two of those doctors, Keiger and Cottle, were given 60 day extensions, time for them to negotiate the boiler plate contract they were asked to sign. No such courtesy was afforded Dr. Harris. The Board specifically asked about her contract, and Mr. Edwards, MCDH CEO, and Ilona Horton, the NCFH Clinic administrator, repeatedly avoided the question, finally saying there was no contract for her. There was and it expired the next day.

If you are a patient of Dr. Harris' our ire has been wrongly been directed at the hospital board. We should be appealing this to Bob Edwards bedwards@mcdh.net and Ilona Horton ihorton@mcdh.net though continuing to copy Gayl Moon gmoon@mcdh.net, conduit to the board, is very wise.

I also learned that her patients have been lied to. (Three of us at the meeting had different stories told to us.) Some were told she was retiring, others told she's experienced a medical emergency. I repeat what I said in my original letter, this was an immoral act on the part of the clinic and hospital CEO, but I've discovered it may have also been illegal under CA law. We shall see how that plays out.

The important thing to know about tonight's meeting:

Nothing will happen. Nothing can happen. She's not on the agenda.

There can be no vote to reinstate her because it isn't the board's job.

Tonight, all we can do is show support for her.

Please don't get confrontational with the board. Our best tool is to tell our individual stories.