Wednesday, March 23, 2011

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, 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  

Sunday, March 13, 2011

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

Sunday, March 6, 2011

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