MCDH Board Members looking for a Quick fix!
Grasping for a lifesaver before finding out why the boat is sinking.
Last fall, while campaigning, the majority of Mendocino Coast District Hospital (MCDH) Board of Directors candidates stressed buzz words like “transparency, collaboration, community input, supporting staff, answer community questions with clarity, honestly and not just with, “It’s complicated.”
These popular and populist promises are quickly disappearing in the rear-view mirror with some of the new MCDH Board members as they hit the road running. In the first two months they have fired the CEO and now appear to be barreling down the road to affiliation with another medical system, with a presentation at the February meeting by Jason Wells, President Adventist Health Howard Memorial and Adventist Health Ukiah Valley Hospitals. It’s unclear as to how this proposal made it to the podium without going to either the Finance or Planning Committees, although it appears it came out of discussions between Karen Arnold and Jessica Grinberg.
Confronting the tough financial problems at MCDH, as the hospital continues to operate in the red, is critical. Like the previous board, once again, it appears major decisions are happening behind closed sessions, with minimal reporting out, ignoring transparency and community input. The Brown Act was passed to assure public input and transparency with government and a limited scope of subjects are appropriate for closed sessions.
While injured President Karen Arnold was available on speakerphone at the February Board meeting, Vice President Jessica Grinberg facilitated the meeting and discussions. Leaping quickly into the “Hospital Affiliation” agenda item, Ms. Grinberg turned to John Redding for the Finance Committee’s input on the topic. Mr. Redding appeared surprised by this question and could only answer for himself, given this topic was not discussed at either the Finance Committee or Planning Committee meetings this month.
Mr. Redding also ran on the same issues of transparency, community input and especially financial stability, which he appears to be fulfilling. Responding, he recalled, that he ran for office planning on tackling financial issues with full battle gear on, to keep the hospital open and independent, while this conversation appears to be surrender without exploring any options. John said he was willing to look at affiliation as a potential strategy, although he thought it should be only one option that needs to include other systems as well, in the financial plan he intends to develop. He implied that moving quickly with affiliation, without a plan and exploring other options, was premature, by leasing out the hospital without fighting to keep it independent first.
Mr. Wells launched into an overview of the strengths the Adventist system could offer MCDH, minimizing previous coastal issues regarding women’s health, especially a woman’s right to choose and abortions. The Adventists’ are now affiliating with hospitals which also have employee unions. Last time MCDH went down the affiliation road with Adventists, it was rumored they passed on our hospital because it has an employees union, which makes one wonder if this presentation was an intimidation tactic with the current deadlock over labor negotiations. Abortions were also a hot topic then, although surgical abortions stopped while Bob Edwards was CEO.
The Board voted unanimously to study this affiliation proposal by an Ad Hoc Committee. Asked whether there would be a vote regarding Ad Hoc Committee members, Jessica replied, “No, I’m going to appoint them,” after which she appointed herself and Amy McColley as Board Members of the ad hoc committee. (Karen Arnold and Jessica Grinberg were the members who brought Affiliation forward with Jason Wells, not Amy McColley as previously reported.) John Redding abstained. We hope there are positions for public oversight on this committee at publicly accessible times and locations.
Transparency and community input appeared to take another hit as Carole White’s concerns were ignored, at both the Planning Committee and Board meetings. She reminded people that appointing new members had been using an inclusive process, although it is not written in stone with bylaws. Previously, people applied to join a committee, attended a meeting and generally gave a short presentation regarding their skills and interests in MCDH. While there were apparently two Planning Committee applicants, Jessica Grinberg, via emails to committee members, was going to move one applicant forward for membership, without either person attending a meeting or presenting themselves. While I am hopeful this new member will be a fabulous addition, it is disconcerting that Ms. Grinberg took this route when it would have been easy to follow the transparent and inclusive process. Regardless of qualifications, it is actions like this which alienate the public. If I had been that other candidate, I would be extremely angry and distrustful!! Fortunately, the Finance Committee followed the more inclusive and accepted practice with their new members. The vote to appoint Ms. Cecilia Jimenez to the Planning Committee was 4-1 with John Redding abstaining.
Promises of transparency, honestly answering questions clearly and community input were dashed when Myra Beals asked why previous CEO Wayne Allen and another familiar person were in the audience. All of them just stared at her and Amy finally said that they were going back into closed session. Since CEO interviews were on the closed session agenda, they could have just said they were doing that, especially since I do not think they reported out closed items at the beginning at the meeting, as required by the Brown Act. This should not be repeated, since it is a Brown Act violation.
We are concerned that Closed Session is again making all sorts of decisions behind closed doors, regardless of whether it is appropriate or not, without respecting the Brown Act. We realize this group is new, although several cited their leadership skills as a reason to elect them, and they need to get the training needed to be effective and follow the law. It does appear that the Association of California Healthcare Districts (ACHD) leadership training certificate Steve Lund proposed is vital, although that lengthy process may come too late to provide the experience, skills, transparency and accountability required to make MCDH healthy, keeping it open and independent!
This report was corrected in italics, with feedback from MCDH Board Member Amy McColley. We encourage people to provide feedback on our website so we can share your thoughts with the audience.
Hello Mendocino TV:
I do not believe MCDH has a future as an independent hospital. I am attaching below a letter I wrote in January prior to Bob Edwards’s termination. Since then our financial situation remains dire- we are looking at a $1million deficit this year, and that’s with the parcel tax. In addition $19 million is needed for repairs and improvements, and seismic requirements due by 2030 which cost Howard Hospital/Adventist $85million. The voters recently approved the parcel tax to “save” the hospital. Well, that won’t save our hospital-it merely puts in on life support for another year or two. When we taxpayers understand the true cost of maintaining MCDH as an independent hospital, we are not going to be happy.
You make good points about transparency. Ever since I finished my term on the Board of Directors, I’ve asked subsequent members to tell the public the real cost of maintaining MCDH as an independent hospital. Nothing has been forthcoming. I don’t think they’re concealing anything. They don’t know, and the reality is too difficult to bear..
To the editor:
The philosopher J Krishnamurti once said: “If you ask the right question, you get the right answer.” There has been much community discussion whether Bob Edwards, the CEO of Mendocino Coast District Hospital, should retain his position. Our new Board of Directors will make that decision. But I would submit to you that merely changing the captain of the ship will not prevent our hospital landing on the rocky shoals of financial disaster. So, the question we need to ask is “what do we need to do to preserve the long-term sustainability of our hospital?
How bad is the financial situation at Mendocino Coast District Hospital? Well, pretty dire. Statements show-and this is with the parcel tax added-a loss of $331,000 to date. Well, OK, maybe with a few tweaks we can break even, maybe even make a bit of money. But what about our physical plant? Mike Ellis our CFO says, “We don’t have the cash to buy new carpet or tile. We only do what we have to do to keep our license.” (Jan 10th Board meeting). Bob Edwards, our CEO, says (at the same meeting) we need $19 million just to keep the doors open and the rain out. On top of that by 2030-rapidly approaching-we need to be in compliance with the new State seismic requirements. That means either an expensive retrofit (does that make sense for a hospital built in 1971?) or a new building—$25 million? $50 million? $75 million? Who’s gonna lend us the money, when we’re not even in compliance with the requirements of our measly $6million existing bond? What about our hard working hospital employees who have had wages frozen for several years?
Sometimes it falls upon physicians to be the bearer of bad news. I was on MCDH Board of Directors from 2010 to 2014, and when I joined the Board, I had a strong feeling we did not have a sustainable financial path as an independent hospital. We needed to affiliate with some entity that would provide capital for our physical plant and produce economies of scale in running our operations. However, as with many of my former patients, giving up independence is a difficult thing to accept and no Board member would support me in my quest for affiliation. Subsequent Board members have entered full of enthusiasm to “save the hospital.” But none-as far as I can determine- have looked in any significant way for outside help, and our financial situation has continued to deteriorate.
What about our neighboring hospitals? What are they doing?
Sonoma Valley Hospital finalized an affiliation agreement with University of California San Francisco Health to create an integrated health network. “We plan to be the Diagnostic Center for UCSF patients in the North Bay with our new affiliation, and already attract patients from outside the district for pain management and other procedures,” CEO Mather said.
Sonoma West(formally Palm Drive Hospital.) after considerable financial struggle, has transformed into Sonoma Specialty Hospital(a long term care facility) under a new management services agreement with Advanced American Management Group. It plans to have Urgent Care, bundled with outpatient surgery and long-term acute care.
Petaluma Valley Hospital, a district hospital like ourselves, but larger at 80 beds has an interesting history: In 1997 PVH entered into a 20 year lease with St Joseph’s to operate the hospital. In 1997 PVH decided not to renew the lease, and other candidates emerged, finally signing with Paladin Healthcare. However, the complexities of unravelling the electronic medical record that was joined to the hip with Santa Rosa Memorial proved too formidable, and the agreement was rescinded. PVH has re-engaged with St Joseph, but under the newly formed (and still awaiting regulatory approval) joint operating company with Adventist Health.
This year St joseph Health (owner of Santa Rosa Memorial) and Healdsburg Hospital (a 21 bed district hospital) agreed to begin formal discussions about St Joseph Health taking over operations and management. “Small hospitals are impossible to keep afloat without a strategic partner to help with financial issues,” said Sue Campbell, board chair, Healdsburg District Hospital.”
If you look at Mendocino and our surrounding counties-Humboldt, Lake, Sonoma, Napa-there are 18 acute care hospitals. Of those 18 hospitals only ourselves, Mad River Community Hospital in Arcata, and Phelps Community Hospital in Garberville(9 beds) are independent.
“Nobody wants us,” I’ve heard it said. According to Bob Edwards “Early in its passage through bankruptcy Coast Hospital asked five hospitals about possible affiliation. No one was interested.” (quoted in Advocate 1/25/18). Well, I was on the Board at that time, and that’s not a true statement. (In pursuing affiliation options, one must be careful with existing management. Since affiliation may mean administrative changes, management can see this as a job security issue.) Hospitals in worse shape than ours have gotten partners: Colusa Hospital, which closed due to financial collapse, has reopened its doors under American Advanced Management Group. Healdsburg Hospital, noted above, has an $8 million operating loss, only partially offset by $6 million parcel tax and intergovernmental transfer funds.
One day an elderly patient of mine came in for a routine appointment. Prior to her visit, I received a call from her daughter- the patient was driving on an expired driver’s license, her house was a mess, and she was surviving on cat food. When the patient came in, I suggested, as gently as I could, that she needed a different living arrangement. “No,” she replied, “I want to remain independent.” Yes, it’s hard to give up autonomy, and admit the fact one can’t go it alone, but do we want the health care equivalent of surviving on cat food?
Buz Graham, MD
I absolutely agree with MCDH joining Adventists. Independent hospitals are no longer viable financially nor are we helping our health needs by ignoring chronic bankruptcy. It’s time to move forward by joining sustainable health care system as proven by Adventists.
Surgical abortions at the hospital were always a small percentage and require a physician to perform them. The majority of therapeutic abortions are done in physician offices, or clinics. It is my understanding that they stopped at MCDH because there are no physicians still performing them.