No TLC for the Transitional Care Unit

Her grandmother came to California in a covered wagon; her grandfather fought in the war...not World War II or I, but the Civil War; her mother was 103 years old when she passed away and lived in three centuries; and her father suffered from “lumbago” and died from “consumption.”  This was more than just curious information told to me in my first encounter with Emma, as her past painted a parallel picture of our evolving nation.

Emma was the first woman in her family to graduate from college, receiving a degree in English, and periodically she reminded me of her involvement in The Daughters of the American Revolution.  When I first visited her home to see her ailing husband twenty years ago, they proudly displayed an oversized American flag on their porch.  After he passed away, I didn’t hear from her for about five years until a phone call requested a medical visit.

Time did not age her, although because of her infirmities she was now using a walker.  Our discussion noted no life-threatening conditions, yet emotionally she was indifferent except for the roses she tended around the fencing of her small house.  “Roses are fussy and difficult to grow, but I pamper them with gentleness and kind words enticing them to fill my home with their sweet aromas.”

As with many of my senior patients, I encouraged her to find “purpose” and broaden her social community by returning to church, volunteering at the senior center and hospital, and exploring her previous writing talents.  She obliged me, but I knew there was a spiritless shell struggling with internal battles. 

At the same time in early 2006, Robin Clough, Volunteer and Activity Director at the SCV Senior Center, and I learned the Henry Mayo Hospital Transitional Care Unit (TCU) would be closing.  For many of our elder seniors, it served as a stepping stone after discharge from the hospital, allowing them to gradually return to normal health and go home as opposed to going to a nursing home.

Within a few weeks, we organized a steering committee, had a “Rally in the Valley” meeting, then protested the closure with pickets in front of the hospital.  We chose the day and time to coincide with the hospital Board of Directors meetings, which was mid-to-late afternoon.

The call went out to our elder seniors in Santa Clarita to come to these hospital rallies, and I was happy to see Emma on the first day.  It fit her character when she claimed the picket sign that read:  “I’m the Little Old Lady from Santa Clarita”!

Over the next year, seniors rallied at the hospital five times, spoke at City Council meetings, and publicized the plight of the potential loss of the TCU.  One scorching Santa Clarita day, we were forced to bring the rally and our picket signs into the hospital.  We had already discussed the legality of this with the SCV Sheriff’s office, so we knew our rights, yet hospital security came to put us back on the street. 

In the main lobby, as one hundred seniors (some on oxygen and in wheelchairs) lined the hallway and quietly stood with their signs, the head of security came with an entourage of seven other officers and emphatically told us to leave.  Knowing the law, I told him we wouldn’t, and then he threatened to take our signs.  Unfortunately for him, Emma was standing next to me, and this 100 pound, 92-year-old clinging to a walker, shook her sign in his face and said, “You’re not going to take this sign away from me!”  (There were a few extra words I left out which were not a part of her degree in English.)  I knew Emma had not only found “purpose”, but had passionately grown sharp thorns like her roses!

At the third hospital rally, Robin noticed a change in Emma and pointed it out to me...she was wearing makeup!  Curiously, I went over and asked if she was okay.  She said she felt fine, but after a few moments confessed, “I think I’m in love”.  “His name is Don, and he’ll be here in a minute”, as she told me about the kindness and commonality of her 95 year old friend.  In the next moment, she looked worried.  “I am afraid though...”  as I cut her off and said, “You mean of him passing away?”  Without hesitation she retorted, “Of course not...I’m afraid and worried one of these pretty ladies here might take him away from me!”

Later that day as we marched, I noticed them holding the sign together, and the wording was changed to “I’m the Little Old Lady & Man from Santa Clarita.”

Eventually our efforts allowed the TCU to remain open for 19 months beyond the Board’s directive because of community and city protest.  Don though had indeed been hospitalized twice, and in failing health was placed on hospice in the TCU just before it closed.  He passed away with Emma at his bedside.

Emma continued to have purpose and give her opinions.  It was difficult for her to understand how the Board of Directors ignored the plight of the community they serve and look at our elder seniors as only numbers to balance their books, and not as people who have history and emotions.  She insisted the TCU allowed for seniors to stay close to family and friends in our valley, receive care from their longtime local physician, maintain their dignity and hope, and especially not go to a nursing home.  I could only agree and knew the money saved by the hospital was minuscule compared to the financial and emotional stress seniors now face.

For several more years I continued to see Emma at her home, and she continued to tend her roses.  Next to her American flag was the picket sign she and Don carried during our rallies.  Emma became ill earlier this year, and was hospitalized several times.  Finally, she requested in-hospital hospice care which was granted.

Although weak and fragile, Emma was still lucid and clear.  She was comfortable and without pain, and was not suffering.  On a Thursday evening, I came to see her...and she had makeup on!  I told her she looked great, and she told me she wanted to look good when she saw Don. That evening, Emma passed away.

Periodically, I go to Eternal Valley to see Emma...and I bring a rose so she can smell the sweet aroma.  I also make sure the rose has a lot of thorns...I know she would like that.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

 

HMNMH Conflict of Compound Interest

There has been an exorbitant amount of outrage pinned against the salary and bonuses received by corporate executives, but blaming has ignored the real source for anger: the Board of Directors. These individuals not only set salaries and hire (and fire) a Chief Executive Officer, but ultimately make policy and direct future goals which are paramount to a successful organization. Most of us have no concept nor understanding what it is like to sit as a member on a Board of Directors, but when chosen to be one of these leaders, how prepared are we in assuming this role?

An initial reaction is to make a beeline for the nearest copy of “How to be on a Board of Directors for Dummies”, yet what we bring to the table is our innate understanding and experiences of life. Having personally sat on multiple Boards and chaired a few, there is a learning curve where skills and insight are honed and evolve over time. Not having sat on a Wall Street Board, I will limit my discussion to the experience of non-profit Boards, such as we have at Henry Mayo Hospital (HMNMH).

Diversity of opinion is critical in having a well-rounded hospital Board, so appointing individuals not only knowledgeable in healthcare, but well-versed in finance, real estate, construction, and community needs is important. This seems to fit the profile we see on the HMNMH Board of Directors.

Our Board of Directors are not paid for their services. Therefore their valuable time is contributed for the selfless sake of our community healthcare. Should they donate professional services on their own time and expense without expectation of anything in return, we ennoble and respect their altruistic efforts. But should their personal profession intertwine financially with that of the hospital, State laws for non-profit 501(c)3 organizations prevent conflict of interest.

The term 501(c)3 refers to the IRS Revenue Code which mandates the rules and laws non-profit corporations must follow. State law under the auspices of the California Attorney General requires “no more than 49% of the directors may be ‘interested persons’.” Like any law, wide interpretation may be wielded blurring legal clarity. It makes sense though you would not want someone with special interest to takeover a non-profit entity for their own personal profit-making interest.

So a question that beckons an answer is can all Board of Director members be free of conflict of interest? As a physician, I know some hospital contracted doctors who are well-qualified in their medical and business expertise, but would be disqualified on serving if not for the 49% exception. Because they are a Board member, they must recuse themselves should the voting concern their business. This is simple, fair, and common sense.

Should hospital money be deposited in the bank of Board members, construction contracts be given to Board members, or medical office building real estate leasing be brokered to Board members, recusing themselves and not voting on any of their business related issues is simple, fair, and common sense.

Although Board members might seem to be absolved of their conflict of interest through voting recusal, in reality there is a clear appearance of impropriety. Could a Board member vote on other hospital issues be swayed and influenced from fear their deposits, contracts, or leasing be threatened? The answer is simple, fair, and common sense…of course! This is the indelible crux of our problem.

There are many bankers, contractors, and real estate brokers in our valley that would be willing to give their input and expertise in improving our community healthcare without expecting any financial benefit in return. These are the altruistic Santa Claritans we should honor and put on a pedestal, who rise above the appearance of impropriety while removing the intertwined financial relationship of Board members with the hospital.

Our community should fear the undue influence on Board member votes, as this is leading our hospital down a misguided path. Their votes resulted in outrageous executive salaries with hidden bonuses the public is not privy to. Self-serving interest has taken over our hospital and threatens it’s viability. The hospital Board of Directors must be held accountable, and if you do not question nor scrutinize this Board, you probably read a copy of “How to be a Dummy for the Board of Directors!”

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

Drainage of Our Unsung Nursing Heroes

Being a hospitalized patient is one of the few moments in life where we sense our greatest vulnerability. Distracted by illness and not being in our home-comfort zone elevates fear and apprehension. At that moment, the most easing and reassuring words one can hear are “I’m your nurse.” The role of nurse has changed markedly since the time of Florence Nightingale. Not only do we see gender integration, but technology has hurtled nursing beyond the simple “fluff your pillow”. career.  It is a profession in the 21st century that must maintain knowledge of medication, alimentation, surgical procedures, and computerized monitoring.  Yet, nurses still must be empathetic and sympathetic as they sooth away our worries and distress.  Their skills are honed with time and are invaluable in the healing process.

Nursing is not stress-free, and requires not only continual interaction with patients, but also doctors, families, pharmacists, social workers, discharge planners, and Administrators.  Coordinating all of this is an expertise I know is not outrightly appreciated.

One of my  home-bound patients was hospitalized at Henry Mayo Newhall Memorial Hospital (HMNMH) with a complex medical problem requiring surgery and a stay in the Intensive Care Unit.  After “turning the corner”, she was transferred to a regular unit for her final recuperation before discharge.  Discussing her improving symptoms during “rounds”, she stopped me before leaving and said:  “I just want to let you know how ‘synchronized’ and wonderful the care has been by the two nurses on duty today”.  She had felt the care at HMNMH was good, but she wanted to emphasize that day how her nurses were especially “professional and outstanding”.

With that, I checked the nursing board for their names and asked the ward clerk to have them meet at the nursing station.  As I wrote my progress note, I peripherally saw them sit down tentatively near me.

One of the nurses has been at HMNMH for several years and has always done a great job.  The other was new.  As I looked up at them, there was clearly an unease to their body language.  I told them what my patient had said and commended them on their skills, at the end giving them my appreciation and thank you for their outstanding care.

I was taken aback for a moment as silence fell on the discussion, and then I noticed both had tears in their eyes as they excused themselves.  Later, one came back and thanked me, expressing how they had been guarded initially because they thought I was going to tell them something they did wrong.  I reiterated my thanks, but was saddened by the realization of how rare it must be for them to be complimented on their work.

In twenty three years at HMNMH, I have seen unskilled and uneducated individuals work their way from changing bed sheets, to become skilled and educated Registered Nurses.  For many, this was not an easy task as they balanced work with family and school.  Unfortunately, many of these professionals leave our hospital because of the same threats and intimidation embattled physicians now face (see WRB Henry Mayo Hospital Rant & Rave for previous articles).

Certainly, many people have trouble with their employer, but judging from the numerous nurses who leave our valley to practice at other hospitals, HMNMH has a problem.  As the “only bakery in town”, the Administration knows no one wants to trek on the crowded freeways to another job, but this flow is like a leaky bucket, which truly effects patient care.

It all comes back to the duty of the volunteer hospital Board of Directors to recognize this problem.  We have already seen the reckless money-draining rubber-stamp of million dollars projects (cardiac catherization lab, NICU, heart by-pass surgical suite) by this Board, so why would nurse’s tears be on their radar?

To be an effective Board, they must diligently work to find out what is really going on at our hospital instead of relying on a single source for information i.e. CEO Roger Seaver.  Not only do they have a fiduciary responsibility to this community, but they are demonstrating to the public they are “not in touch” with the true needs of Santa Clarita.  Draining this valley of it’s most precious professional resource, nurses, is a reflection of their irrational decisions without rational input. 

Statistically, the Board is being told there is no problem.  The best American companies rely on “exit interviews” to find out why people leave their organization, and I’ve demanded to see these interviews for years, without success.  Every former nurse and employee of our hospital I’ve encountered has informed me they were not given this interview when they left.  Can our reputable Board members possibly not understand the importance and necessity of this tool to improve HMNMH?      

The Board of Directors must not continue to ignore problems and be swayed by personal propaganda.  They should meet with the physician Medical Staff and Medical Executive Committee in open dialogue without influence from CEO Roger Seaver.  Improving patient care should be our focused goal.   

Hopefully, the common ground we find will allow us to give nurses the worthy “thank you” they deserve. 

Gene Dorio, M.D.- Guest Commentary
Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

Patient care is in jeopardy at Henry Mayo?

Patient care is in jeopardy at Henry Mayo Newhall Memorial Hospital (HMNMH) with The Joint Commission (TJC) sanction listing failure to communicate between hospital Administration, Board of Directors, and the physician Medical Executive Committee (MEC).  To rectify this problem, the HMNMH Board of Directors invited the Medical Staff to a meeting on Tuesday, May 31st.

This event was held in the hospital cafeteria which was closed to the public, but many concerned Santa Clarita residents learned of this non-confidential meeting and asked me if they could attend.  As a first and important step in enhancing communication, it seemed best to initially keep the meeting private.  One of my close friends insisted I be his “West Ranch Beacon (WRB) fly on the wall” knowing how important this dialogue is to the community.

The hospital cafeteria is elongated and setup with tables so all could eat dinner and commingle prior to the meeting.  Seated near the podium with me were many members of the MEC.  Opposite us at the front were CEO Roger Seaver, and in between were the Chief Medical Officer, Dr. Richard Frankenstein, and new Board member, Dr. Richard Corlin.  Across the back of the cafeteria were other Board members, mostly seated together.

Board Chair Craig Peters opened the discussion with an introduction by each Director.  Statements were made of personal experience heartening their commitment to improve the hospital.  Many of us were inspired and inspirited by their sincere expressions of responsibility.  For this “fly”, it was the calm before the swatter.

Mr. Peters then launched into his version of the Medical Staff “Vote of No Confidence” against the Administration and the Board of Directors, the timeline concerning “2-4-2” mediation, attacks and retaliation including code of conduct, corrective actions, and “resolutions” against Medical Staff members, and removal of the Deputy Chief of Staff as a voting member of the Board.  A chorus of opposition countered from MEC members as to the misrepresentation of facts and information without merit or truth.

As a “fly” on the wall, and a newly elected member of the MEC, my knowledge of some of this information was limited, but my colleagues, with their vast experience and understanding attempted to clarify the incorrectness of what Mr. Peters was stating.  One physicians even exclaimed, “I’m apoplectic with rage at the inaccuracies you are promoting”.

The issue of Board “conflict of interest” did not escape them either but this was marginalized quickly as they follow “due process” keeping them above reproach.  For this “fly”, it was the usual “we haven’t broken the law” retort.

Mr. Peter’s contention any money he may have personally made was magnified in a return donation back to the hospital.  He claimed my reported assertion in the WRB concerning his conflict of interest was incorrect.  Questioning him if there were any falsehoods or non-truths in my articles, he could convey none.

The new Board member, Dr. Richard Corlin, provided an “Outsiders’s Perspective” with his statements concerning violation of Medical Staff By-laws and Rules & amp; Regulations, and “illegal meetings” by the MEC, which were the same propagated six months prior by CEO Roger Seaver. 

At this moment, the “fly” had an epiphany:  The information Dr. Corlin and Mr. Peters were providing came from the same source.  This same information was being provided to Board members, yet physician members of the MEC highly contradicted the factuality of this information.  The source of this information:  Roger Seaver.

Now it was clear:  Non-factual information was being presented to the Board dividing the two sides, creating animosity and the TJC sanctioned lack of communication. Roger Seaver seemed to be deliberately keeping the MEC and Board from communicating!

Now I realized why an annual “retreat” between the MEC and Board is canceled; why an annual Medical Staff/Board dinner dance is canceled; why a Leadership Council between MEC and Board leaders is canceled; why a $350,000 consultant blamed the MEC for communication problems yet never addressed the Administration role; and why I and other MEC members had received an e-mail the day before this meeting:  “Hello, the meeting that was scheduled for Tuesday 5/31/2011 to meet the Board has been canceled and will be rescheduled soon” from an unknown hospital sender.  This last odd and sinister contrivance comes from the depths of malevolence.

Some Board members embrace the opinion of Roger Seaver, and the conflict of interest effect on their vote cannot be discounted.  There is a simple solution for all Board members:   You must renounce any financial ties with the hospital.  If you sit on the Board, you will not have money in your bank, you will not bid on construction contracts, you will not lease any hospital nor G&L property, and you will not have any medical professional contracts for services. 

Can Board members eliminate any appearance of impropriety?  Or will this community continue to think financial dangling of conflict is affecting the Board vote, and ultimately creating an adverse effect on patient care at our hospital?

Recently, the Board of Directors voted to change the hospital “Mission, Vision, & Values”.  Before the change, listed under “Values” was integrity, trust & respect, accountability, teamwork, clinical competence & quality, and compassionate care.  Eliminated now are trust, clinical competence, and compassionate care.  Was this change Freudian?  Even a fly deserves better.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

HMNMH Administrator Overboard!!!

President and CEO Roger Seaver of Henry Mayo Newhall Memorial Hospital (HMNMH) in a recent local editorial described the hospital’s leadership as a “three-legged stool” of Administrators, Board members, and Medical Staff. Seemingly, the Administration has seized influence over the Board of Directors to “break the Medical Staff leg” attempting to eliminate their participation in patient care decisions at our hospital.

The Trumanism “The Buck Stops Here” shoulders accountability on the Board of Directors to make decisions free of domination and outside control. As in any business, this Board is responsible for oversight of Administrator Roger Seaver, but is Administrative induced financial conflict of interest tweaking their decision-making?

There are fifteen members of the Board of Directors and their votes decide the direction of policy and healthcare for our hospital. (Nomination to be a Director comes from a Governance Committee overseen by the Board - in itself, fodder for a future posting.) They are governed by By-Laws and documents laid out under the auspices of State and Federal law.

There are five doctors on the Board. Only one physician (Chief of Staff Dr. Frank Yusuf) elected by the Medical Staff has a vote, as this number was recently and contentiously decreased by the Board. The other four doctors are not physician-elected and became Directors through the Board Governance Committee.

First, here are facts about eight of the fifteen Board members:

1. Board Chair: Craig Peters - Executive Vice President Industrial Properties -CB Richard Ellis. Leasing office space for Medical Office Building #1 (not yet built) through G&L Realty.
2. Board Treasurer: James D. Hicken - President and Chief Executive Officer Bank of Santa Clarita. HMNMH has money in his bank.
3. Vinod Assomull, M.D. - contract with hospital for dialysis center.
4. Dale Donohoe - Owner, Intertex Companies, presently building-out the NICU.
5. Elizabeth Hopp - Sr. Vice President/Director of Client Services Bank of Santa Clarita. HMNMH has money in her bank.
6. Mark Liker, M.D. - contract with hospital for neurosurgical care.
7. Roscoe Marter, M.D. - Ob/Gyn for Facey Medical Group who has contract with hospital.
8. Roger Seaver - CEO has contract with hospital.

Second, one must ask these Directors: Does having money in your bank or a contract with your business, or the threat of losing these financial deals, impact your Board vote?

Finally, conflict of interest occurs “when an individual or organization is involved in multiple interests, one of which could possibly corrupt the motivation for an act in the other.” The IRS and California law requires conflicted “interested persons” not to make up more than 49% of the Board of Directors of a nonprofit public benefit corporation like HMNMH.

Even though eight of fifteen Board members might seem to have a financial conflict of interest, I’m sure hospital lawyers have made sure this Board “legally” does not overstep the law: they don’t own the bank; the contract is with G&L, not the hospital; they happen to be the lowest contract bidder; or, they recused themselves from the vote. The law has guidelines scrutinizing “direct or indirect” financial conflict of interest as well as the “appearance of impropriety”, which might negate hospital lawyers’ tenuous legal rationale.

Laws may not be broken, but a far more important question is: What about the moral and ethical rules we live by and teach our family and children? Is business so callous we now ignore or tweak what is right or wrong? If this is the kind of disregard they have for the rule of law, then what moral character guides them in making medical decisions for this community?

We might not know whether financial conflict of interest plays a role as we tally up the votes. An indication though of potential conflicted votes (affected at the behest of the Administration) may be seen in recent “Resolutions” and changes in their By-Laws made by the HMNMH Board:

• lengthening Board of Director term limits an extra three years (to 12 total years)
• removal of Deputy Chief of Staff as voting member of the Board of Directors
• hiring an outside consultant (reported $350,000) claiming Medical Staff is responsible for communication problems ignoring the role of the Administration
• decreasing Medical Staff application fee (to deplete the Medical Staff Treasury, lessening legal representation)
• rebating past (10 years) fees to doctors from Medical Staff treasury (again to affect legal representation)
• a veiled hiring of a Judge to oversee Medical Staff elections
• using “secret files” and “code of conduct” to block physician re-appointment
• creating an Administrative position known as “Chief Medical Officer” (reported $22,000/month) potentially violating confidentiality and HIPAA law

The bottom line though: Is the HMNMH Board making good decisions, or are these decisions only coming from a single Administrative viewpoint?

As presented in previous WRB postings, the catherization lab, neonatal intensive care unit (NICU), and designation of the new surgical suite for cardiac backup might be a costly overextension of services which results in a return to bankruptcy. If anything, it will place undue financial stress on other departments and services which can diminish patient care.

A present reflection of the level of patient care is the general overall low public opinion this community has for the healthcare rendered at HMNMH. Private, as well as State and Federal surveys, reveal a comparatively low level of patient care, as does The Joint Commission sanctions brought against the hospital. A “Vote of No Confidence” by the Medical Staff against the Administration and Board of Directors earlier this year again was a result of physician difficulty dealing with patient care problems at our hospital.

We must put “three legs” back into hospital leadership allowing not only Medical Staff input and self-governance, but insist the Board regain oversight of Administrator Roger Seaver, removing any semblance of financial conflict of interest. As the Board of Directors spiral toward being a “one-legged stool”, the public must demand transparency, for if this is not attained, patient care will suffer as will healthcare in this community.

Gene Dorio, M.D.- Guest Commentary
Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

Losing Your Doctor, Losing Patient Care

“Just business, nothing personal” is an oft-quoted apology in godfather-type movies justifying an unemotional action usually with a negative result. Recently, as I was visiting my patient at Henry Mayo Hospital, I overheard a disturbing conversation with a family in the adjacent bed telling them their loved one had to be discharged that day. His wife was pleading with staff the limited home care they would be provided was not adequate for her elderly spouse, and the impact would affect her physical and mental health also. Other family members at bedside also pleaded to no avail, as the patient was discharged home. “Just business, nothing personal”. The next week I noticed his return...to the ICU.

No one is able to predict how well a patient will do after discharge, and many times I know there are risks we take. Quite often, when I’m asked to predict outcome, I tell my patients and their families “My initials are GRD, not GOD!”

The hospital is paid by insurance companies and Medicare based on the diagnosis: four days for pneumonia, five days for heart attack, etc. Beyond that predetermined length of stay, the hospital will push for discharge. “Just business” These standards are set to shrink costs and whether you like it or not, we all must deal with this ongoing problem.

How does one put a dollar sign in front of adequate health care? Basing a pneumonia discharge solely on a chest x-ray or blood test is wrought with danger. Again, dealing with risk, physician experience and advocacy allows better and secure “reading of the tea leaves” than standardized care.

As a physician for 30 years, my expertise folds into the picture not only the patient’s health, but also family, living situation, physical and mental capabilities, finances, and legal aspects of the total problem. Understanding this “full picture” improves the chance of surviving discharge, achieving their previous quality of life, and not returning to the hospital...and yes, saving money.

What if though physicians were taken out of their patient advocacy position, which is being perpetrated by our hospital? In a local newspaper editorial, CEO Roger Seaver analogized hospital leadership as a “three-legged stool” including Medical Staff, Administration, and Board of Directors. With financial conflicted control of the Board of Directors by Administration, we have a “two-legged stool”. Together they are personally attacking doctors through insults, deprecating remarks, “Resolutions”, veiled “code of conduct” and “corrective actions” threats, and annihilation of their independent voice which has outraged physicians into a “Vote of No Confidence” against them. I for one have no confidence in sitting on a “one-legged stool”!

All physicians who admit patients are not employed by Henry Mayo. The intention of the hospital is to hire and control your doctor, thus removing the main advocate for you or your loved one’s health care. What will be the impact on patient care? Out-rightly, physicians will be told when to discharge patients by Administration regardless of how your doctor might feel...and most importantly, how you feel. More subtly, concerns over medication errors, screening of new physician applicants, “sentinel events”, and standards and criteria for ancillary caregivers will be compromised. “Just business, nothing personal.”

There are some who don’t regard the doctor-patient relationship important in their health care. When you become an elder senior though, it becomes a prerequisite to have someone be an advocate, accountable, reliable, and aware of your medical and personal problems. This trusted, caring, and confidential doctor relationship has always set the basis for health and well-being, and goes to the deepest part of our spirit.

After serving as a healthcare advocate for this community for years, Dr. John Cocco was contentiously suspended by the Board of Directors on January 5, 2011, leaving many physicians to take over care of his hospitalized patients. Moving from “Just business” to something “More personal”, I lastly present to you a pertinent dedication I wrote and distributed to Medical Staff and my friends in the community earlier this year:


As a hospice doctor, I was asked by Dr. Terrazzino to see a patient for end-stage respiratory disease on Friday evening. She had been hospitalized just after New Years, but the reality of three futile weeks attempting improvement convinced the family end-of-life care was appropriate.

Her medical record indicated this 88 year-old women was a smoker and had a history of Alzheimer’s dementia. Noting an artistic background, she had worked as an animator for Hanna-Barbera for many years, reminding me of fond days watching The Flintstones and The Jetsons.

Entering the hospital room, I greeted her and introduced myself. Not in distress, but clearly uninvolved, she acknowledged my presence. Knowing the underlying problems, yet wanting to access her mental capabilities, I asked my usual sequence of mental status questions.

Where were you born? “Vienna.” Ah, I thought...a good start. How old were you when you moved to the United States? “Four.” A thread of hope that mentally she was better than the record depicted. Where did you move to...and grow up? “I can’t remember.” Were you married? “I think so.” Is your husband alive? With a sad and withdrawn look she responded, “I don’t know for sure.”

Midway through, I realized her memory was seriously deficient, but despite this reality, I discussed her medical problems and my role in assuring comfort and minimal pain. It was difficult to understand whether this fragile soul truly could comprehend our conversation.

My last question to her was “who is your doctor?” As I peered into her eyes, you could see them widen with her face growing into a smile...”Why doctor Cocco, of course!” For a moment, I saw the animation she had put into her cartoons as the memories flowed...and then drawing back and looking to either side of me she asked...”Where is he?”

From the depths of our senses and understandings come profound memories even when there is underlying illness. For four decades, John Cocco has taken care of patients in this community and has had heartfelt effects on them. Indeed, he has had heartfelt effects on us all.

Something to think about.

Yabba dabba doo!

Gene Dorio, M.D.- Guest Commentary
Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

Commentary: Hospital Foundation Perks raise questions about equal care

Most people understand the reasoning behind receiving perks or special access when they participate in some type of program. It’s designed to offer a choice and to differentiate between levels of membership or donation; an incentive to potentially give a greater amount or to entice into spending more. This is fine as long as it is offered openly to anyone that wishes to participate.

When you pay extra to have a special credit card, join a club or make a certain level of donation to a charitable organization, there is usually a set of benefits that come with that purchase or gift. You might get early access to an exhibit at the County Art Museum, discounts at a gift shop or reserved seating at a concert hall; any number of benefits that are available to those that make that choice.

The key is that it is offered to anyone and does not have serious ethical questions as it would with the potential timing of life or death decisions in health care. That is why I have been interviewing caregivers over that last several weeks regarding the apparent perks that come along with the Henry Mayo Newhall Memorial Health Foundation’s Friend of the Hospital (FOH) “Gold Card” program.

So who gets this FOH Gold Card? According to the Foundations brochure, those that get the card include; major donors, Legacy Circle (planned gifts or bequests), Board Members of Hospital or Foundation, Support Group Presidents, Special requests of Foundations donors, board members and volunteers, and Community Leaders.

You may want to re-read that list once more as it basically covers just about anyone that they feel like giving the FOH Gold Card to except of course the “regular folk” that aren’t connected. Doesn’t that smack of nepotism or even trying to curry favor with decision makers who are only offered it for their position?

The Beacon was able to confirm that some Santa Clarita City Council members have received the FOH Gold Card under the guise of “community leaders.” Although, some Council members prefer to go down to Holy Cross which should make you wonder if they know something we regular folk don’t!!

The brochure that the Hospital Health Foundation hands to recipients states clearly that; “The FOH program is not about special treatment, but is about recognizing and thanking individuals for their generosity and support of Henry Mayo and making their visit to our facility as comfortable as possible.” But according to various House Supervisors, Nurses and Doctors, the program is all about special treatment including apparently kicking “regular folk” out of rooms so that an FOH card holder gets a private room.

On one occasion, according to an interview, a FOH member pulled out his Gold Card and demanded a private room when admitted to the hospital after he had been placed in a double room with another patient. Apparently all single rooms were full that night and the Nurse respectfully told him she could not accommodate his request. The FOH member called a hospital administrator in the middle of the night, prompting a phone call from that senior administrator to the chief nurse on duty, who was told to move the other patient, the “regular folk,” out of the room and give it to the FOH member.

One Nurse spoke of the fact that health care staffers were required to identify Gold Card patients on the white boards, also known as the census board, or medical charts with the “FOH” initials. In fact, one nurse we spoke to was reprimanded for not moving a FOH to the head of the line in the ER even though there were more serious patients that needed immediate attention according to the triage process.

Personally, I don’t have a problem if Foundation volunteers bring FOH members a gift basket, newspapers or even give special VIP meals. Those perks seem perfectly reasonable as a thank you to a donor. But, once you start giving preferential treatment in healthcare to one group over another it crosses over to an unethical class system; the haves and the have not’s.

Jumping FOH members to the head of the line; bumping “regular folk” from hospital rooms or cutting into an operating room ahead of those already scheduled is not an acceptable practice. Having the Charge Nurse become a Private Nurse for an FOH patient takes away quality of care from the other “regular” patients.

About a month ago a homeless woman was found dead in the ER waiting room at Henry Mayo after visiting the ER three times the night before. She was complaining of arm and wrist pain; had no insurance and was discharged after each visit. A hospital spokesperson stated that the hospital “…treat homeless people with the same compassion and care as all our patients. We care for everybody, regardless of insurance or an address.”

I wonder if she had had a FOH Gold Card would she have been found dead after being mistaken for sleeping in the waiting for seven hours after her last discharge from the ER. It makes me think that if you don’t have a FOH Gold Card that you might potentially get the same level of care as that unfortunate homeless woman!

Although the brochure clearly tries to make sure no extraordinary treatment is given to the FOH Gold card carriers, it’s evident from speaking with a number of people who work at or are affiliated with the hospital, that there is clearly a wink & a nod that goes with having the card. According to our sources, hospital house supervisors, after hour’s administrators and case managers all appear to take special interest in FOH patients especially with their health care.

We should all be appalled, but not surprised, that in this day and age anyone gets "special" treatment in a health care situation, especially due to financial or political influence. The “free pass”, as one local medical professional put it, is a “kick in the ass to everyone else” and should be seriously resisted by the local healthcare community. Our valley deserves top quality health care for everyone regardless of race, color, creed, sexual orientation and social or political status.

What do you think?

P.S. - This is a developing and continuing story. If you are a local health care professional and have information, stories or documentation that you would like to share with The Beacon please pass it on. Know that your efforts will be kept in the strictest confidence as some of your colleagues will already attest to. Thank you!

Dave Bossert- Commentary

Dave Bossert is a community volunteer who serves on a number of boards and councils. His commentaries represent his own opinions and not necessarily the views of any organization he may be affiliated with or those of the West Ranch Beacon.

To anyone who cares about HENRY MAYO NEWHALL MEMORIAL HOSPITAL:

Because of several management issues, I find it almost impossible to do my job and fulfill my responsibilities in caring for patients. I am horrified at the lack of professionalism in this Hospital when it comes to human resources and administration. How can specialized, well educated, dedicated employees work under the direction of people who don’t know how to communicate well, problem solve, or support their staff in a respectful and truthful way.

Personally, I thought I was hired to deliver the finest care to patients, their families, and help facilitate support and assistance post discharge. The patients I work with are specifically in tremendous need of staff who can communicate, problem solve, with respect and care. I can easily provide these services when the environment is conducive. It is an uphill struggle to work well when superiors are damaging morale by; intimidating, harassing, and retaliating.

There are issues that are destructive to staff morale and hinder patient care; in this case we are told to work it out with our supervisors (with whom we have the problem with). The next resort (even though our supervisors warned us not to go above them) is going to Human Resources which is sadly another brick wall. The person in charge is terribly inadequate and unable to handle the magnitude of the issues presented. When staff is unsupported and complaints are ignored, it is frustrating to continue taking grievances into that department. In my experience, this is when policies suddenly change (only to support their position), or they resort to lying (to make it seem like you are the problem). Or make it impossible to meet the terms of their unexpected, spontaneously revised demands, in an effort to squeeze out and sanction resignation (of the highly qualified, extremely competent employee). I’ve witnessed this right before my eyes. This is crazy making at least.

Employees are terrified of losing their job, so they remain silent, watching but unable to speak out for fear contingent paychecks could be compromised. These individuals have families who depend on this income. So it continues…on and on….

Signed,
HMNMH Employee name was verified but withheld by
request to protect the individual from retaliation!

Guest Commentary: On the frontline at Henry Mayo

Being a patient or visitor in a hospital is an emotionally gripping experience sometimes leaving an indelible imprint on our mind. Walking through the halls of Henry Mayo Hospital, one sees families leaping in joy for their newborn and the sadness of their grandparent dying. It is a holy place wrapped with fear of an unknown diagnosis and newly created technologic quagmire of computers and HIPAA legalese. Some only notice the antiseptic buildings and hallways, but inpatients sense greater detail of the daily ongoing life in a hospital.

As a patient, you are reliant on the caregivers around you. When this care is seamless, traversing illness as they work toward a diagnosis is made easier even when not feeling well.

On the frontline are nurses and ancillary caregivers, as well as primary care physicians known as “attendings” who act as quarterbacks interacting among staff, specialists, family, and Administrators. I have been an attending physician at Henry Mayo Hospital for 23 years and know these relationships are integral to total patient care.

In this effort, I must also work with ward clerks, dietary, physical and occupational therapy, respiratory, housekeeping, transportation, discharge planning, and the various departments of lab, radiology, and surgery. Coordinating the “team” allows inpatients to be nurtured back to health and return home, get back to work, and regain their quality of life. Doctors accept this challenge and fight a battle to bring good healthcare to our community.

There is an analogy with this challenge in a war setting. Last week, I enjoyed lunch near the hospital on The Alamo patio with two Vietnam veteran friends, Bill Reynolds and John Cocco, M.D. I never served in our military, although there are some that might want you to believe I am a veteran of The Alamo...indeed I am! But through Bill and John’s heroic efforts, I had the opportunity to complete my medical training to serve on a different front.

Relishing the peaceful mood and serenity of the day, I listened to their long-gone and far-off days of being soldiers and the highs and lows of their exploits and experiences. Specifically they explained, whether it be arms, armor, munitions, food, or back up, they never lacked supplies. They were proud to serve and happy to return home, and as they shook hands and parted, from their lips echoed “I’ve got your back”.

Their stories of military organization, though, reminded me of how critically important a hospital must run...again, seamless. Our frontline soldiers, Bill and John, both told me how responsive their military administrators were to their needs. At our hospital, this does not happen, and that is why I believe our state and national survey results suffer. Not being responsive has brought with it problems.

We have a new ICU and Emergency Room with state-of-the-art equipment where our patients get outstanding care. Once an inpatient leaves these areas though, it is a different story.

Nurses are especially effected because should tools or supplies not be provided for patient care, they risk losing their hard-earned license. Their complaints, especially of “team nursing”, have settled on deaf ears. Additionally, because of “tightening of the belt”, many services have diminished (housekeeping, dietary, respiratory, physical and occupational therapy) which directly effects the ability to bring our patients back to health.

In war, you worry about dying. At Henry Mayo, you fear loss of your job. This attitude comes from the upper levels of Administration as the licensing of intimidation filters down to lower levels of patient care. Healthcare professionals commit to “saving lives”, “helping others”, and “making a difference”, but sadly many would prefer working at other hospitals if not for the close proximity of Henry Mayo.

Administrators and Board members will quickly jump to say I’m wrong. But in those 23 years I have been at Henry Mayo Hospital, other than physician Board members, I have NEVER seen a Board member on the medical floors! Only rarely do I see Administrators. How can observations by professional frontline caregivers like me be trumped by the Board or Administration?

There is a war on the home front being fought by your physicians for better patient care. Unbeknownst to the community, donated dollars are being spent by the hospital to overwhelm physicians using multiple lobbyists, lawyers, and public relations people. Their propaganda depicts doctors as the enemy, claiming our unwillingness to negotiate, fake outrage that Administrators are the victims, and patient “length of stay” is reflective of poor physician care.

In reality, the Administration and the Board have been the aggressor suspending and marginalizing doctors through “Resolutions”, claiming election fraud, using ‘secret files’ blocking re-appointments, and false “corrective action” and Code of Conduct violations. They need to check for their image in the mirror!

The public needs to ask for a forensic accounting of spent monies at our community hospital. Let them prove to us “tightening of the belt” squeezing nursing, ancillary care, and supplies are being used wisely for patient care, and not going into the pockets of possibly conflicted Board members. Is there a private agenda behind the cloak of their mission statement?

I was told by a Board member to stop whistleblowing and not wave hospital dirty laundry in the public eye as it gives them a bad name. If the laundry were clean, there would be no need for whistleblowing.

I salute all physicians, nurses, and other ancillary caregivers for their common humanity and effort to bring healthcare to this community. Hopefully, the reason for working at our hospital will one day not simply be because of proximity. We are fighting a war for better patient care and promise Santa Clarita, “we have your back!”

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with including the Medical Executive Committee and Medical Staff of Henry Mayo Hospital, or those of the West Ranch Beacon.

Guest Commentary: Forefathers, Foresight, and Insight

A letter dated March 24, 2011, from HMNMH President & CEO Roger Seaver to the Medical Executive Committee (MEC) asked for “corrective action” against a “disruptive” physician; me. The release of this confidential letter to the West Ranch Beacon (WRB) from someone in the Administration mirrors the clandestine individual known as “Deep Throat” during the Watergate affair. Now Santa Clarita has Mayogate with their own colluding “Deep Ear, Nose, and Throat”! All kidding aside, the MEC has waved confidentiality allowing me to openly discuss this letter.

The accusations were twofold: I breeched confidentiality of Dr. John Cocco in one of my WRB articles, and as Treasurer of the Medical Staff, I have not performed the duties of the office. Both are incorrect as Dr. Cocco read and approved my article before posting, and I have yet to receive any written queries concerning financial information from the Medical Staff.

This is clearly an Administration attempt to thwart free speech affecting my ability to accurately report healthcare problems at our community hospital through the WRB. Our Forefathers would be appalled, and I will continue to act as a whistleblower to protect patient care.

Reiterating the understanding where “balance of power” at Henry Mayo is amongst the MEC, Board of Directors, and Administration, Roger Seaver and the Board are trying to overpower physicians and take over the MEC by any means possible.

In the 23 years I have been on Medical Staff, there have been no letters like this from any CEO. But since January, there have been three: to the Chief of Staff, Secretary, and Treasurer. All accuse us of being “disruptive” physicians. The Administration was unsuccessful swaying the election of MEC members in December, so now they have resorted to making false claims and accusations in removing us from office, and even from the Medical Staff. Who will be next?

The Santa Clarita Valley must understand this critically important reality: The MEC’s fight for good patient care is a barrier against the Administration and Board’s poor healthcare decision-making.

Throughout the country, hospital Medical Staffs have been quietly taken over by Administrations, but California law keeps them at bay by recognizing self-governance of physicians. There have been efforts to skirt around this issue by Administrations, and some Medical Staffs in California have fallen because of legal costs.

The foresight 11 years ago to hire legal representation for the Medical Staff allowed maintenance of self-governance. Recently, the hospital Board enacted many “Resolutions”, one of which decreased staff application fees and forced refunds to applicants with the intention to deplete the Medical Staff Treasury.

In this chess match, the Medical Staff increased their annual dues as a stopgap and the Administration has taken issue with this increase. Physicians are fighting to prohibit business people from making medical decisions, but ultimately this depends on access to legal representation.

What is at stake: patient care. The Medical Staff and MEC feel patient care is compromised at our hospital. The Administration and Board are not only attempting to remove experienced and well-trained physicians from the Medical Staff, but also: equipment and supplies are constantly in shortage on the medical floors and ORs; building security and patient safety are often breeched; credentialing of personnel in procedures and newly set-up computers is lacking; inadequate nurse staffing is disguised under “team nursing”; and insufficient operating room capacity and scheduling mentioned in previous postings.

The financially conflicted Board of Directors is looking the other way as they work to crush the MEC, so I implore our elected officials to come forth to ask questions and gain insight about our hospital. Where is Mike Antonovich, Cameron Smyth, Sharon Runner, Tony Strickland, Buck McKeon, and the City Council? The MEC barrier is not impermeable, and our representatives must help shore it up. Who will save those who save you?

When the British called our Forefathers “disruptive” colonists, it did not stop them from fighting back. I proudly stand with my MEC colleagues as “disruptive” physicians for the right of our community hospital to have the patient care “We the People” deserve.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with or those of the West Ranch Beacon. You can also see more of Dr. Dorio’s commentaries on Henry Mayo Newhall Memorial Hosipal at http://hospitalrantandrave.blogspot.com/  

HMNMH Financial Accountability - Our Scarlet Letter

Bankruptcy...a foreboding and forbidding word made more obtrusive in our poor economy. Whether it is in business, or at a personal level, it brands a scarlet letter on your reputation.
The news is replete with stories of poor decisions, failed management, miscalculated investment, and sometimes criminal manipulation allowing this spiral into the abyss. In most instances, warning signs that may have prevented problems were ignored because of lack of information, education, experience, and sometimes, personal character.

A decade ago, our hospital passed through a turbulent time of bankruptcy as a result of poor management. Realignment was completed, yet, is the potential for recurrence brewing on the horizon? In this conversation, I would like to place on your radar three hospital financial areas that have the potential to fell the first domino: the neonatal intensive care unit (NICU); cardiac catherization lab; and soon to be completed surgical suite.

About four years ago, at a public hospital-wide meeting, an Ob/Gyn doctor asked CEO Roger Seaver whether Henry Mayo would ever have a NICU. His response was the hospital “financial feasibility study” revealed the population of the Santa Clarita Valley would not support one: “At this time, if we have a 12-bed unit, only 2-3 beds would be utilized, making it not financially worthy to have this unit.”

A “financial feasibility study” considers demographics and all potential startup and operational costs associated with a project. As well as the hospital physical facility, staffing with appropriately trained nurses, physicians, and other ancillary personnel must be considered in the package.

Since that meeting, the Antelope Valley opened 12 NICU beds, and Holy Cross will soon open their 12-bed unit. Yet, we have started construction of our 11-bed unit, using the contractor who sits on the Board of Directors. Let’s see, using my abacus...24 new NICU beds just north and south of us, and a slight growth in the Santa Clarita population...suggests a miscalculated investment.

When Mr. Seaver was asked about the previous “financial feasibility study”, his response was “the community wants the NICU!” Well, I want a Mercedes, but my budget can’t afford one! Still, where is the new NICU “financial feasibility study” supporting their construction, and has the Board of Directors seen it?

Further extending this conversation, a father wrote in the West Ranch Beacon his concern when a “tube was lost” in his newborn daughter at Henry Mayo. Trouble ensued when investigation was delayed because physicians were not appropriately notified of this “sentinel event” (an unanticipated event resulting in death or serious physical or psychological injury). For some doctors, it seemed like a “cover up”, and many insist the hospital did not want bad publicity while trying to promote the NICU.

Pressing forward, catherization labs allow us to visualize dye in the coronary arteries of the heart looking for obstruction, then use balloons or “stents” to intervene and open the vessel. Our cath lab at Henry Mayo is limited in scope and cannot be used for this intervention because by law, one has to have surgical backup should there be complications. Makes sense.

Therefore, very few cardiac catherizations are done at our hospital, and the Administration admits they are losing money on this project. But should we not re-examine the “financial feasibility study” presented for the cath lab in case we originally suffered from a bout of correctable myopia?

Many doctors felt the hospital space occupied by the cath lab was not used wisely. More operating rooms were requested to utilize this space, which made financial and patient care sense, but this was loudly and adamantly rejected by Administration.

Several times, I have questioned Administration about financial losses from the cath lab, and potentially from the NICU. They agree, but when asked how those losses would effect the rest of the hospital, they felt “other areas” of patient care would be financially “sacrificed”. Let’s ask HMNMH nurses about this rhetoric, and how recent staffing complaints of this “sacrifice” effects patient care!

As a physician, an ever present danger is cardiac complications from any procedure, and because the hospital has failed in the past to notify physicians of “sentinel events”, will we know of these complications in a timely fashion without a “cover up”?

Finally, the most contentious battle has been the lack of hospital operating rooms (ORs) for this community. I spoke many times at City Council concerning failure of the hospital Master Plan to address the absurdly low ratio of operating rooms compared to all hospitals in Southern California. My words went unheeded, and even though there are only three available ORs, articles by a local newspaper still promotes the hospital illusion there are eight!

As I continually claimed the hospital Master Plan was “greed disguised as progress”, one of my other comments at City Council concerning the hospital expansion was this: “There are some things we do in life, and some things we don’t. We wouldn’t buy a car with three tires...we wouldn’t buy a house with no bathrooms...nor would we buy a Dodger dog without the hot dog. So why would we expand a hospital...without building a hospital?”

This may have pushed forth the construction of a 4th operating room, which Administration felt would pacify the surgeons. With upcoming completion of this new OR, reality has again struck the doctors as now the hospital wants to make this OR provide surgical by-pass backup for complications in the cath lab. Sounds good if we can now do “intervention” with balloons and stents.

But...where’s the “financial feasibility study” to have an experienced cardiovascular team as backup? Not withstanding, the cost of the equipment in the OR and possibly ICU will be in itself outrageous. Will we pursue this project because of “community needs”, or conveniently ignore facts our budget can’t afford?

By law, the new OR suite will be “off schedule” whenever a study is being done in the cath lab, and this has enraged surgeons. Doctors have fiercely complained surgical schedules are severely compromised affecting trauma and our elder seniors because of the lack of ORs. They feel they have been deceived by Administration rhetoric with an OR to be used for cath lab back up, which once again limits their patient care.
At a recent meeting, Roger Seaver announced new OR privileges for by-pass surgery, again maintaining “community needs”. Really? I believe the “community needs” to know the potential financial threat that he and the Board have overlooked in their zeal to mislead physicians and “cover up” sentinel events. We’ve had Watergate, Tigergate, Kanyegate...now we have “Mayogate”!

Lastly, I’ve never bought a car with three tires, and I’ve never bought a house with no bathrooms, nor have I bought a Dodger dog without the hot dog. But should you buy the hospital rhetoric, be prepared to brand a scarlet letter on our reputation.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with or those of the West Ranch Beacon. You can also see more of Dr. Dorio’s commentaries on Henry Mayo Newhall Memorial Hosipal at http://hospitalrantandrave.blogspot.com/  

Stacking the Deck with “Big Guns” and “Heavyweights” at Henry Mayo

When Henry Mayo Newhall Memorial Hospital (HMNMH) opened in 1975, our valley filled with pride as this was a non-profit, locally-run facility for community healthcare. Through the years, we have loudly proclaimed how our hospital is governed by those who live or work in Santa Clarita, and until recently, this was true. Forces are slowly ebbing this away.
The hospital Board of Directors presently number fifteen, with five doctors, and the others from various backgrounds of business, education, and law. Understanding how they are chosen and the importance of their vote in directing hospital policy allows one to see how power and control can be wielded for good...or evil.

By-laws govern this Board and define their make up, duties, and responsibilities. How they are nominated, how long they serve, their interaction with the physician Medical Staff, and guidelines of conflict of interest are clearly delineated by this document.

Under the By-laws, a Governance Committee selects candidates for nomination when a position opens on the Board (which is not very often since a member can serve three consecutive terms of three years, meaning 9 straight years). What if though the Governance Committee is dominated and controlled by one individual?

Roger Seaver has this power and control and wields a wide swath with his sword. Once his personal selection passes through the Governance Committee and is placed on the Board, financial influence (which might be judged as conflict of interest) beckons them to vote in his favor.

For instance, the Board has recently voted to: increase the length of their term on the Board; overrule the Medical Staff credentialing process potentially allowing unqualified physicians to practice at our hospital; ignore The Joint Commission (TJC) standards violations putting the hospital accreditation in jeopardy; hire a Chief Medical Officer (CMO) not mentioned in hospital governing documents which is sanctionable; remove the Deputy Chief of Staff’s vote marginalizing physician participation; suspend a decorated veteran doctor from the staff; pass “Resolutions” against the Medical Staff affecting patient care; etc., etc. Some of these are regurgitated from past WRB postings.

The deck has been stacked with By-laws changed or just violated in order to gain votes and control. The Board moral compass is misdirected, and can only be changed by those in our community who have sustained fortitude and lack fear to fight. But why not by them?

I have had recent and past contact with 11 of the 15 Board members, and their actions, or inactions, perplex me. As a physician, I am expected to interpret information yielding treatment for a diagnosis. Red flags sit in front of this Board representing clear manipulation of information that should prompt questions, or at least stir their curiosity:

1) Administration hiring of a consultant for $350,000 to only conclude the Medical Executive Committee (MEC) was the sole source of communication problems; 2) G&L Realty contribution to City Council candidates to affect their vote, and their financial relationship with Roger Seaver; 3) building offices and parking structures without guarantee of building a hospital; 4) not having enough operating rooms to serve this community in comparison to other hospitals; 5) public denial of the existence of privileging Gold Cards, and; 6) a “Vote of No Confidence” by the Medical Staff against the Board and Roger Seaver.

The most obvious red flag just occurred under their nose and shamelessly demonstrates this whole surreptitious process. The Medical Staff “Vote of No Confidence” was almost unanimous except for one dissenting doctor vote. This physician has been fast-tracked through the Governance Committee and will sit on the Board of Directors beginning in April. I wonder for which side he will cast his next vote?

Another recent addition to the Board, Dr. Richard Corlin, does not live nor work in this community. He is on the faculty of the Institute of Medical Leadership run by former highly paid CMO, Dr. Susan Reynolds. Her recent replacement, Dr. Richard Frankenstein (who does not live and had not worked in Santa Clarita) is also on this faculty. The ebbing away of local influence at our hospital shows how they keep it in their family...not ours.

Certainly, we should have the best qualified physicians associated with our hospital whether they live or work here. But should it not bother this community when hospital spokesperson, Andie Bogden, recently stated in our local newspaper when referring to Drs. Corlin and Frankenstein as “big guns” and “heavyweights”. Maybe her Freudian slip should have been “hired guns”.

Through the power and control of CEO Roger Seaver, the hospital has ramped up their battle against our local physicians to suspend and destroy doctors and eliminate their voice. Will the Board be oblivious to the significance of these red flags?

As the Board of Directors travel this ill-gotten road, they are twisting their fiduciary responsibility to our community by hiding and not reporting sentinel events; contemptuously closing the elder senior safety net, the Transitional Care Unit; and

demonstrating fiscal irresponsibility lacking “financial feasibility studies” for the cardiac catheterization lab, neonatal intensive care unit, and heart by-pass surgical suite which may put us back into bankruptcy. Is this now a careless and “care less” attitude of the Board doing business?

Our community pride is gone and patient care is suffering, and with the Board of Directors led by Roger Seaver painting themselves into a corner, accountability follows closely behind from the IRS, State Attorney General, TJC, and Medicare.

As a physician who serves this community everyday at HMNMH, what keeps me hopeful are the spirit of the doctors, nurses, and all ancillary personnel who still work with great pride to take care of fellow Santa Claritans. Their dauntless task of providing healthcare to our community has remained unshaken during this crisis.

Some members of the Board of Directors are the mouthpiece for the Administration, but others I hope will find their voice. If not, we must work to reshuffle the deck and hope the cards fall in our favor, so the community can proudly proclaim “we have our hospital back.”

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with or those of the West Ranch Beacon. You can also see more of Dr. Dorio’s commentaries on Henry Mayo Newhall Memorial Hosipal at http://hospitalrantandrave.blogspot.com/

Decorated Veteran Becomes Collateral Damage at Henry Mayo

One of the issues surrounding the recent “Vote of No Confidence” by the HMNMH Medical Staff against Roger Seaver and the hospital Board of Directors concerned suspension of longtime community physician, Dr. John Cocco. As a founding doctor of our hospital 36 years ago, his life story is not only reflective of our community, but also the strength and courage of who we are as a nation.
John Cocco was born in Concord, Massachusetts, site of the beginning of our Revolutionary War, Paul Revere’s ride, Henry David Thoreau’s Walden Pond, and the writings of Ralph Waldo Emerson and Louisa May Alcott. In and of itself, he was already in auspicious surroundings which would immensely affect his life.

Other than the “o” we share at the end of our last name, Dr. Cocco’s father, Luigi, emigrated from the Abruzzi region of Italy where my grandfather was also born. Arriving in America, Luigi worked in the coal mines of Pennsylvania before moving to Concord, where he was a “weaver of wool”.

Growing up broad and open-minded in the Concord environs, John Cocco attended Dartmouth College, and being offered a full scholarship to McGill University - known as “the Harvard of Canada” - he enrolled in medical school in 1959.

His internship was completed at Royal Victoria Hospital in Montreal, and then he returned to serve the poor at Albert Einstein University in the Bronx. But there was a far greater calling as he volunteered and joined the United States Air Force, and was sent to Tan Sun Nhut Air Base outside Saigon in 1967. There he served as Medical Director rescuing wounded soldiers on the battlefield, and in some cases, flying the critically wounded to Japan.

“I was very lucky not to be hit by gunfire, nor shot down by rockets”, yet he describes his experience in Viet Nam as “rich and rewarding” adhering to his commitment and allegiance to our country.

Being there for one year, the decorated Major John Cocco, returned to the United States, married his high school sweetheart, Brenda, and moved to the Los Angeles Air Force Station in El Segundo for his last two years of military service.

Looking for opportunities after discharge, the Newhall area, with three hospitals, seemed like a beautiful place to start a family. Yes, there were three hospitals in this valley before HMNMH: Golden State Hospital (at the corner of Lyons and Wiley Canyon - where Vons is located), Golden Valley Hospital (on the other side of the tracks from the bowling alley on Soledad), and Newhall Community Hospital (near Main and 6th Streets).

Dr. John Cocco set up his practice of Internal Medicine in 1970, and was associated with many physicians, some of whom continue to practice, including Drs. David Mysko and Doug Gadowski. In addition to focusing on our elder senior population, Dr. Cocco attends to many residents at LARC Ranch who need assistance.

He and Brenda have raised three children, who still live in the area, and he enjoys cooking, drawing, poetry, and culture. He speaks four languages, and I hear him constantly serenading hospital nurses and patients with songs like “O Sole Mio”.

Obviously, Dr. Cocco is not your typical doctor. I have been in the hospital late at night and seen him sitting at his patient’s bedside with family discussing health problems while holding their hands. He provides empathy and sympathy in a way we have been engrained to see in a Marcus Welby physician, yet he still has managed to provide state-of-the-art medical care to sustain those who are critically ill. His father may have been the “weaver of wool”, while he has truly become the “healer of humanity”.

For some reason Dr. Cocco has remained fixed in his aging process, whereas graying hair and accented facial lines (a kind way of saying wrinkles) has afflicted the rest of us. When I first came to HMNMH, Dr. Cocco would introduce me: “This is my nephew, Dr. Dorio”. Now, with my age catching up with his, its: “This is my cousin, Dr. Dorio”. His work has kept him young!

Dr. Cocco’s compassion and humanity have served our community well. Why is it though Roger Seaver and the Board of Directors have suspended him from the Medical Staff? The answers are cloaked in a legal system which won’t allow me to have this discussion.

I can only say our community should be enraged at behavior by this CEO and Board against a decorated veteran physician who has provided outstanding devotion and dedication to our hospital and country. He has become collateral damage in their “game plan” to gain financial control and power over our hospital. This sense of outrage must go to the deepest core of your consciousness and soul.

Like those at Concord 236 years ago, you must make your voices heard. We need a Paul Revere to ride through our streets and ignite a new Revolution against these tyrants. Like Jo in Louisa May Alcott’s “Little Women,” we need courage and relentless determination to call out for what is right, against this wrong.

Here is a gentleman from immigrant parents; earned a medical degree; served our nation in war; and now serves our poor, elderly, and disabled. He is truly an AMERICAN HERO who is being forced out of practice to fulfill the financial needs of cooperate business. Dr. Cocco has benefitted this community, whereas they, through their conflict of interest, have benefitted themselves.

Although Henry David Thoreau may not have said this to them, an immigrant descendent with an “o” at the end of his name does: “Don’t allow financial temptation be a disservice to your moral character.”

I can only hope, through united community resolve, the halls of our Henry Mayo Hospital will once again be graced with the sounds of “O Sole Mio”.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with or those of the West Ranch Beacon. You can also see more of Dr. Dorio’s commentaries on Henry Mayo Newhall Memorial Hosipal at http://hospitalrantandrave.blogspot.com/ 

HMNMH connecting the dots.........................

There are two separate articles in our local newspaper concerning Henry Mayo Hospital leaving the reader to connect the dots. They are the front page controversial removal of Dr. Greg Jenkins, Deputy Chief of Staff, as a voting member of the Board of Directors, and tucked away on a back page an announcement of newly appointed Board member, Dr. Richard Corlin.

Why would Dr. Jenkins, who has lived and worked in Santa Clarita for 25 years, be eliminated from our hospital Board of Directors by someone who does not live nor work in our community? Let me bore you with some of the details.

Followers of the West Ranch Beacon “Henry Mayo Hospital Rant and Rave” are aware of the illegal and irresponsible hospital appointment of Chief Medical Officer, Dr. Susan Reynolds. The hospital insists the physician Medical Staff recommended her to the position. Going back to our core problem, The Joint Commission (TJC) sanctioned the hospital for poor communication between the Administration and Medical Executive Committee requiring a Mediator to intervene. Dr. Reynolds was recommended as a Mediator, to be paid jointly by both sides.

Stunningly, within two weeks of her acceptance, the hospital announced appointment of the Mediator as Chief Medical Officer (CMO) for a reported salary of $22,000 per month. Additionally, she was contracted to receive an additional $100,000 to find a permanent CMO. It was obvious the hospital could care less about the TJC sanction, and seemed ready to dangle money to gain influence.

With the hospital now fully paying her salary, it was not surprising Dr. Reynolds, under the guise of her title, ramped up their “game plan” and became a source to propagandize conflict and acrimony against the Medical Staff instead of enhancing communication.

Immediately, a new lengthy and vague “Code of Conduct” was adopted by the hospital Board of Directors supplanting the old one, giving the Administration power to falsely accuse, bully, and intimidate physicians. Nurses, who will testify in court to this, were solicited by Administration to create “incident reports” against doctors to trump up charges! I then had my own ironic experience with this growing outrage which is not so boring.

On February 9th, Roger Seaver, CEO, led an open “State of the Hospital” meeting in the cafeteria informing the public of activity related to nursing, construction, goals, etc. During this presentation, Dr. Reynolds stated a “change in the culture” where there would be no “yelling” tolerated, and “respectful dialog” would now be maintained. Mr. Seaver stated “I want the intimidation factor eliminated from this hospital”, and Board of Director Chair, James Hicken, concurred in his comments. Physicians have always felt this way, being held accountable at every level for our behavior.

Part of Mr. Seaver’s presentation revealed a “Vote of No Confidence” by the Medical Staff against the Administration and Board of Directors. This discussion, although contentious, was a valid exchange of opinions by doctors, Board members, and Administration.

As I turned to address Mr. Hicken seated toward the back of the cafeteria, a hospital Administrator, seated about five feet behind me, chimed in yelling “You called me a crook and a liar!” and continued this haranguing and finger pointing for about 20 seconds. (I believe he was referring to my WRB “Rant and Rave” postings which has not called anyone “a crook and a liar”...yet.)

What was bothersome and disconcerting is Dr. Reynolds, Roger Seaver, and Mr. Hicken observed this behavior without once intervening, even though they had just criticized this type of intimidation. How they expect to have a “change in the culture” when those advocating this change are not impressed to affect those around them presents a difficult slope to climb.

Returning to our original question and trying to connect the dots to the new hospital Board member: Dr. Reynolds is also the President and CEO of The Institute for Medical Leadership, and going to that website

http://www.medleadership.com/faculty.htm you will find on her organization’s faculty Dr. Richard Corlin. Anyone surprised? Not only do we have an outsider now on the Board and your local physicians have lost a vote, but this reminds the community of past dubious indiscretions by Roger Seaver and his involvement with Beverly Hill’s G&L Realty.

Radio personality and columnist Michael Josephson, honorably promotes “character counts”. All of us make mistakes and cross the line, but how we handle these mistakes and accumulated experiences influence the evolving of our character and growth into better people.

The hospital Administration and Board of Directors is crossing the line too often...ignoring sanctions, dangling money, and creating a bullying environment. Connecting the dots exposes them queuing up giving favoritism as they scratch each others back.

We typically reserve the term “bully” to kids and young adults. But does everyone evolve out of this behavior as their character grows? To answer this, one must just look at the Administration and Board of Directors at Henry Mayo Hospital.

Gene Dorio, M.D.- Guest Commentary

Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with or those of the West Ranch Beacon. You can also see more of Dr. Dorio’s commentaries on Henry Mayo Newhall Memorial Hosipal at http://hospitalrantandrave.blogspot.com/  

HMNMH Doctor Vote of No Confidence; What It Means!

Readers of The West Ranch Beacon and the “Henry Mayo Newhall Hospital Rant and Rave” blog are well aware of the continual controversy surrounding our community hospital. A front page article in the local newspaper headlined “Doctors voice concern in hospital vote” on February 16, 2011 expressed the hospital “hammered out, point-by-point” response to my recent guest commentary here at the West Ranch Beacon titled; “No Confidence in CEO Seaver & Board of Directors”.

As most of you know, the physician Medical Staff voted in a confidential meeting on January 11, 2011, “No Confidence” in CEO Roger Seaver and the hospital Board of Directors. This information was not public until Mr. Seaver breeched the Medical Staff confidentiality by publicly criticizing the vote at an open State of the Hospital meeting on February 9th. With this revelation, the Medical Staff requested their issues be put forth in The West Ranch Beacon (WRB), a free daily digital publication serving the Santa Clarita Valley.

I was criticized by the newspaper for the Medical Staff’s lack of response, but in an e-mail to them I wrote “there are legal details and the shroud of confidentiality that hovers over these problems” making it mandatory physicians be precise in their wording.

The Medical Staff understands the financial noose the hospital has on that newspaper, but we also see their recent nominees for "Newsmaker" of the year include: Roger Seaver, Judy Fish, James Hicken, and Elizabeth Hopp (all HMNMH Board members); and "Business of the Year" nominee Bank of Santa Clarita (where Hicken and Hopp are officers). The Medical Staff is therefore apprehensive about the newspaper being "fair and balanced" in their reporting.

Additionally, one must understand the underlying motivation by the hospital is to control the Medical Staff by subverting the Medical Executive Committee (MEC) through false accusations of being “not honorable” and cheaters. This comes from Roger Seaver who controls the Board of Directors and uses “resolutions” to remove physician participation in hospital decision-making.

Returning to that newspaper article, most of our rebuttal is already contained in past postings here on the WRB. It was clear when Mr. Seaver and Mr. Hicken gave their responses, they felt that no one reads the WRB. Having been “scooped” on this story, it was evident the newspaper does.

Questioning that “Seaver isn’t convinced that the vote is valid” brings to mind President Ronald Reagan’s famous remark, “Here we go again!” Previous WRB postings show Mr. Seaver’s attempts to persistently question and dismiss Medical Staff voting as fraudulent. People cheat, but why would all doctors systematically participate in fraud?

The hospital’s appointment of a Chief Medical Officer (CMO) was controversial, but most importantly, not legal. The State of California and the Federal government legally defines how hospitals and physicians interact inculcating governing documents with strokes of authority. Because specific guidelines are important, almost every aspect of function in this relationship is delineated.

Around the country, hospitals that have a CMO have this position defined in their governing documents. The position of CMO was not described in any HMNMH nor Medical Staff document when the position was created. I can only speak from the Medical Staff side that the By-Laws and Rules & Regulations still do not contain any reference to a position of Chief Medical Officer.

Without the duties and responsibilities of this position being defined, our hospital is at risk for sanctions from State and Federal levels that could potentially close our doors.

Mr. Seaver’s response to the alleged “conflict of interest”: “The Board’s goal is to provide high quality health care to our community, and in all instances to look for the best interests of our community rather than the individual interests of the board, administration, or committee members.” Really?

No influence on your Board members that have: millions of hospital dollars in their bank; million dollar contracts for hospital construction projects; six or seven figure contracts with Board physicians? Too bad some Board members get drunk at the trough!

There are now 14 Board members instead of 15, since a recent “Resolution” removed our Deputy Chief of Staff, Dr. Greg Jenkins, from the Board. The “trusted, decorated veteran and community physician” I alluded to was not Dr. Frank Yusuf as suggested. That suspended doctor, Dr. John Cocco, has been a “target” like Dr. Yusuf.

The Board “Resolution” reducing the physician application fee is an attempt to financially affect the Medical Staff access to moneys they need to fight the multiple hospital lawyers, lobbyists, and PR people. Our battle to protect ourselves and the community is predicated on our ability to retain an attorney, who the hospital attempts to belittle and deprecate.

Throughout the newspaper article, there is a persistent attempt by Seaver and Hicken to raise their banner of “best interest of the community” and “patient care” above that of the doctors. But as rapper Jay-Z wisely observes: “You can say what you say, but you are what you are”.

When the CEO and Board President of our hospital state they “don’t know exactly what a physician ‘Vote of No Confidence’ means” is exactly why we should not have confidence! Let me translate what it means: WE DON’T TRUST YOUR HEALTHCARE DECISIONS!!

Now as I raise our banner, the doctors at Henry Mayo Hospital promise to fight for an improved hospital and better healthcare for the people of our community. So when others line up at the Board trough to join them with their straws, we will be there to put a kink in them!

Gene Dorio, M.D.- Guest Commentary
Gene Dorio, M.D., is a local physician. His commentary represents his own opinions and not necessarily the views of any organization he may be affiliated with or those of the West Ranch Beacon. You can also see more of Dr. Dorio’s commentaries on Henry Mayo Newhall Memorial Hosipal at http://hospitalrantandrave.blogspot.com/