Coast Hospital Blues (& Reds)

A 2013 article in Salon.com declared that “The definition of insanity is doing the same thing over and over and expecting a different result,” had become the most overworked cliché in journalism and public speaking. So when Mendocino Coast District Hospital (MCDH) Chief executive Officer Bob Edwards stepped to the podium at the December 3rd MCDH Board meeting to introduce a strategic plan aimed at passage of a parcel tax the first words out of his mouth were … You guessed it.

One might reasonably expect that Edwards could grasp the obvious irony of promoting a seemingly identical parcel tax to a hospital district full of voters who rejected a similar scheme less than a decade ago. Edwards doesn't appear to be overly aware of messy things like irony when they can be replaced by full speed ahead chutzpah and snake oil salesmanship.

In some sense that's part of the job of a CEO, painting lipstick on a pig. So an Emergency Room (ER) loss of $1.7 million last year for Edwards becomes just the ticket we need to sell the parcel tax to voters. From Edwards' point of view the parcel tax will help offset ER deficits. He stated, "We believe MCDH has a fundamental purpose to save lives and provide emergency care access to every person in our community.

"We believe we hold a special duty and consider it a privilege to pave the way for our neighbors to live, survive, and enjoy a quality of life by having access to life saving technologies via the access to our emergency department.

"We exist to preserve the Coastal uniqueness we have come to love, by helping those in our emergency room extend their life when accidents or illness tries to get in the way."

The flip side of this approach is the simple fact that Mendocino Coast District Hospital's ER lost $1.7 million last year. In addition, the ER has been so slow in serving patients at times that there are noticeable numbers of people simply getting up and walking out of the ER. Why would voters vote to fund such a loser?

Edwards would tell you that ERs generally are deficit departments in hospitals. The CEO's goal is to make MCDH "the best Critical Access Hospital in California." The next line in Edwards' Power Point presentation to the MCDH Board read, "We exist to make a positive difference in patients' lives through excellent care."

In other parts of the Board meeting and in more detail in the MCDH Finance Committee meeting of December 1st, Edwards acknowledged a $250,000 gift from the Hospital Foundation to go toward rectifying long overdue problems with the nurse call system. When the donation came up at the Board meeting, Chair Sean Hogan declared that when he was a patient at MCDH he bypassed the problem by using his cell phone to call the hospital's main phone line, then requesting the nurse's station nearest his room, so that he could have a nurse render the assistance he needed.

At the more lightly attended Finance Committee meeting Edwards admitted that in addition to the nurse call system MCDH also has another million dollars worth of maintenance issues. The most serious issues involve correctly ventilating the operating room and a faulty automatic transfer switching device. The hospital has a final deadline as of the end of December to get the operating room fully functional. Problems with operating room ventilation have existed at least since 2010 when the Joint Commission Accreditation Quality Report noted the OR issue. Very little has been done to rectify the problem until very recently. Part of the OR is being cordoned off by closing a door and employing a special fan in hopes that the combination will achieve adequate enough air exchange in one section of the OR to pass inspection. Of course, the relevance of air exchange in an operating room is that the proper exchange of air helps prevent infections.

It is noteworthy that at more than one public meeting CEO Edwards has implied, if not directly stated, that this year's Joint Commission Accreditation Quality Check proved the hospital had no problems with patient care. What the Joint Commission Report actually states is a re-accreditation for the Home Health Department and the Laboratory (respectively garnering re-accreditation in October and April of 2015). A close inspection of the Joint Commission Report finds that MCDH, as a Critical Access Hospital, is still relying on an accreditation dated August of 2013. In other words, as of the first weeks of December, 2015, the critical access hospital known as Mendocino Coast District Hospital has not been re-accredited as a whole yet.

Edwards' presentation did not dodge a couple of other troubling aspects in MCDH's operations. The CEO acknowledged that, "physician recruitment and retention is an ongoing issue."

At the Dec. 1st Finance Committee meeting Edwards trumpeted the prospective arrival of a new orthopedist next May. Edwards attempted to equate that arrival to a two million dollar moneymaker for the hospital. Statistics generally would prove that true except for the annoying fact that the new orthopedist is merely replacing a retiring orthopod and there will most likely be a four month gap between the retirement and the arrival of the new doctor. Using Edwards' own mathematical logic, those four months could mean a loss of a third of 2016 orthopedic earnings ($6000,000-$700,000).

Edwards has a distinct habit of talking from both sides of his mouth during public speaking. He claimed something akin to a partnership with MCDH's employees union, citing the union's willingness to work through this fiscal year with no raises whatsoever. Astute readers may remember that the AVA reported on the negotiations between MCDH and its union earlier this summer: "The idea to continue under the old contract for one more year [with no pay increase] came from the union. The bigger story lies in what the hospital administration [CEO Edwards] had previously offered the employees union. According to a source familiar with the situation, initially MCDH offered a proposed contract that would have “trashed” the health insurance benefits of the employees, greatly increasing what employees would have to pay out of pocket for less coverage in order to maintain any health benefits whatsoever.

"The union flatly refused that offer. Next, MCDH apparently attempted a divide and conquer strategy by offering the hospital's nurses, lab technicians, and X-ray techs a 10% raise. The flip side of that offer: every MCDH employee below the nurse and tech salary level would end up paying for their own insurance." Not exactly amicable negotiations.

Not everything at MCDH is downcast. Brand new Chief Financial Officer Wade Sturgeon and his staff found hundreds of thousands of dollars lost in "Bad Debt" and turned it into a tidy profit for the month of November. However, that appears to be a one-time only windfall and without the sharp number crunching MCDH would have suffered an approximate $200,000 loss for the month.

In some quarters part of the blame for the financial problems that sent MCDH into bankruptcy (a judge just signed off on MCDH's exit from bankruptcy in November) was placed on lackadaisical management by past CEOs like Ray Hino.

Mr. Hino recently hired on to shepherd the opening of Sonoma West Medical Center in Sebastopol. Sonoma West is essentially situated in the old Palm Drive Hospital footprint. Just over a decade ago, western Sonoma County voters approved a parcel tax to support Palm Drive. The hospital went bankrupt for a second time in April 2014 (the first was in 2007) and closed its doors. However, taxpayers in the hospital district are continuing to pay an annual parcel tax to the tune of $155 per parcel. Mendocino Coast voters might want to consider the ramifications of that potential irony.