OB Committee Meets for the First Time

Chaos & confusion continues at first OB meeting

My hopes for the Mendocino Coast District Hospital (MCDH) Obstetrics (OB) Ad Hoc Committee were dashed when chaos and confusion clouded the organizational meeting on January 6, under the direction of Dr. Kevin Miller.  From the disorganized set up, late start, incorrect agenda to the rambling introduction by Dr. Miller which emphasized this was to collect data and make recommendations, not to place blame or make personal attacks; it was off to a rocky start.

The first hour was taken, as per the agenda, by Wade Sturgeon, CFO, with a long, complex overview of the MCDH OB budget, complicated by the fact there were not enough handouts and they were strewn about on a table.   The basic issues appear to be the need for expensive locums, the need for specialized and highly experienced staff, 24hour/7day on call requirements, reimbursements covering only about 50% of costs and relatively low number of deliveries. (According to the handouts that Tanya Smart brought and was not able to speak of in over 2 ½ hours, in 2015 only 55% of coastal pregnant women delivered at MCDH)

The budget information only covered MCDH expenses, which pays for one half of the OB physician on call costs, while Mendocino Coast Clinics (MCC) pays the other half. It also apparently did not cover some of the cesarean expenses.  This is very simplistic overview and there are many complexities including that increasing births will also increase some expenses, reimbursements vary by payer mix contracts and the OB department absorbs 9% of MCDH costs not directly billable to a department.  Since financial management software was just purchased recently to allocate expenses and income directly to departments, I wonder how accurate all this data is.

The next agenda item was an update from Lucresha Renteria, Executive Director, on the Mendocino Coast Clinics’ OB financials and staffing, a critical component of this mix.  Rather than giving her the opportunity to share, which would give a more complete overview of the total program costs, Dr. Miller jumped to an item where Dr. Keevan Abramson, was to report on discussions he’s had with other doctors regarding their experiences with OB.  (This starts at 1:28)

Downplaying the potential impacts of disbanding OB and potential dangers of delivering babies in an Emergency Department, Dr. Abramson focused on blaming Mendocino Coast Clinics for “not doing their fare share” for MCDH.  While he remembered a meeting he had 20 years ago complaining that MCC was competing with his practice for patients, he doesn’t appear to remember that when MCC took on OB, because the hospital could no longer afford to, in 2005, they also provided two weeks of OB call coverage.  After MCDH started bankruptcy proceedings MCC increased their coverage contribution, which only became the current tremendous locum expense after he and his partner sold their practice to the Adventist hospital chain and there were no longer any other local doctors providing OB call coverage.

Dr. Abramson was added to the committee at Dr. Miller’s specific request and it appeared contrived to me that he skipped the Mendocino Coast Clinics’ report and the birthing trends report Tanya Smart had prepared and distributed, to pursue the emotionally charged diatribe. This move sabotaged the Committee’s attempt to join together with a coherent understanding of the current data to pursue the goal of improving OB services and reducing overall expenses. This action also exhibits a lack of respect to the other professional committee members, who had spent extensive time and work preparing information for this meeting.

In full disclosure, I worked at Mendocino Coast Clinics as the Resource Development Director from 2004-2014 and was involved in some of these activities.  As such, when I see a professional physician attack the organization, shouting out to Dr. Wright in the audience and spreading false information about their finances and responsibilities, I react angrily.

The last half hour of the meeting was very disjointed as Dr. Miller appeared to struggle as he tried to figure out what the next steps should be and what data is needed.

While I had been excited initially to see this OB Ad Hoc Committee begin, given the clear expectations set by President Steve Lund, I am deeply disappointed watching this meeting unfold.  Dr. Miller stopped progress in its tracks by creating contention and polarizing members with the presumptive pronouncements in his introduction through his disregarding the agenda and plunging it into a blamed based solution without first educating the Committee on all the facts.  He may have heard Mr. Lund’s message but he doesn’t appear to have the understanding or skills to bring this group of powerful professional people together to create a comprehensive report.

The committee will meet January 19 at 4:00 pm.

I do apologize for the poor quality of the video and audio, which Mendocino TV voluntarily records.  That room has an underlying hum, there was no amplification and it was not set up in the usual committee structure.