Building Healthy Communities with Marianne McGee Brings you the final OB Committee Report
The final meeting of the Mendocino Coast District Hospital (MCDH) Ad Hoc OB Committee was rushed through by Chair Dr. Kevin Miller, who seemed more interested in getting the meeting over with than the quality of the final report or addressing the concerns of the community volunteers.
Relegated to the cafeteria, full of insane noise and distractions, in some ways it appeared a fitting conclusion to this series of meetings, which were generally poorly facilitated and citizens were not listened to nor respected. Certainly the both times I attempted to think out of the box, citing the strength of community support for OB in the August telephone survey and suggesting that this report look at a targeted campaign with the Mendocino Coast Hospital Foundation, which might attract new donors was ignored and dismissed. Although the MCDH Foundation mission statement is to engage in “fundraising and community involvement that supports MCDH’s ability to deliver quality healthcare services,” people kept insisting it was to purchase equipment. While it has substantially contributed vital equipment recently, it appears that recruiting new donors is out of the question, with the tired old refrain “it would rob Peter to pay Paul”.
Two citizen members, Tanya Smart and Carole White, clearly spent a great deal of time researching the issues and potential new ideas to reduce expenses and increase revenue. In the last meeting they were often told “we needed to move on”, “don’t talk too much” as the Chair interrupted them. At the end, all members were given an option of adding individual thoughts and ideas and hopefully they will do this and may be heard higher up the chain.
A positive result was increased communication and collaboration between Mendocino Coast Clinics (MCC) and Mendocino Coast District Hospital, which have often been in a competitive relationship. The only actual financial shift has been that MCC hired another Pediatrician, who will be able to provide more 24/7 on call services, which are expensive when the hospital has to use “travelers”. Pediatric on call coverage must be available with OB care and are technically the responsibility of MCDH. While generally not required in other communities, MCC also provides half of the 24/7 OB physician coverage at its expense. There were also helpful conversations about MCDH supporting MCC to recruit another OB/GYN physician to provide on call coverage at a much reduced cost compared to travelers.
In fact, the need to hire OB staff on a permanent basis, rather than rely on travelers, is really one of the root expenses at the heart of the million dollar hole. Our low birth rate combined with extensive nursing requirements makes recruitment extremely difficult. This is further complicated by our lower than urban salaries yet high costs of living and lack of professional jobs for other family members. I think MCDH staff became less defensive as the group understands they are working hard to recruit with limited incentives and hefty limitations.
The funding issues are now very clear; OB is the one department that MCDH does not receive reimbursements from funders based on actual coasts and is the one service it is not required to provide by law. While MCDH staff has made some progress increasing reimbursements, between MediCal and the insurance companies little more can be done. And this national healthcare issue is compromised by the total political uncertainty of funding and regulations for all providers. The dependency on “travelers”, who come for a short period of time through agencies well funded to coordinate the service, are the major shortfall. Finding creative new ways to resolve recruiting and retention is key to providing OB care in our community.
While closing OB was not “on the table”, it came up over and over again. This meeting had a lengthy discussion on how to cover the impacts on other hospitals and communities of OB closures, the risks to lives and the community. There was a reluctance to include mentioning that closing would have a tremendous impact on the “most vulnerable population”. Currently the closest OB services in Ukiah will not take new pregnant patients over 20 weeks, so they would need to have all the many pre-natal visits there. This potentially has a tremendous financial hardship involving time off work, childcare and transportation expenses.
While John Allison did an admirable job of being a scribe and writing both report drafts, it was disconcerting to me to hear him say over and over again that if MCDH continues to lose a million dollars a year on OB a minuscule percentage of the approximately 65 million dollar budget, the hospital will close. And according to CFO Wade Sturgeon, no department apparently actually makes a profit nor break even. So, it may behoove the MCDH Board of Directors, as suggested by volunteer Carole White, to take closer looks at all departments, which should be easily accomplished with the new management software.
Hospitals and clinics nationally are being stretched by the current health care situation and rural Community Access Hospitals (CAH) like MCDH are especially hard hit without a corporate or religious machine behind them. We are a Healthcare District with elected officials and powers to tax, so the organization is not expected to make a profit or to break even with its revenue and expenses. Looking forward to needing to have a major retrofit in 13 years, it is a critical time to plan carefully to ensure the hospital remains healthy. It will only be through building honest and transparent relationships with the community, that MCDH can successfully move through these difficult times. While President Lund said this Ad Hoc OB Committee may be a model for moving MCDH forward, it needs to include more skillful leadership, broader community involvement as well as actually listening to what people have to contribute.