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/