Sunday, May 29, 2011

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.

Sunday, May 8, 2011

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 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.

Tuesday, May 3, 2011

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.