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In a workshop Thursday night, the board heard a proposal by Jack Rogers,
director of nursing services, that the intensive care unit be closed,
the obstetrical unit be changed to low risk and patient care time be
reduced from nine hours a day to the national standard of six hours.
Rogers said that the changes would eliminate traveling nurses which cost
$101,397 per year and reduce nurse aide/ward clerks by four. Hours of
both licensed vocational nurses and registered nurses would be reduced.
Dr. James Cam, chief of medical staff, said the ICU is needed for
one-to-one care for critical patients.
Dr. W.J. Bang said that doctors have been through a change in ICU in the
past. Some transfers are difficult to make, and some critical patients
need a registered nurses' constant care.
Dr. Orville Cerna said that physicians lose skills if not able to care
for critical patients.
Board chairman Raul Garcia suggested that the medical staff get with
Rogers and make a decision that would work an make a presentation to the
board.
All agreed with administrator Bruce Birchell that changes must be made
to reduce costs and asked for the board's support for any employee
layoffs that are required.
Three health insurance plans will be considered by the board today: Blue
Choice, Health Industry Trust and Blue Cross. The Blue Cross plan is
already in effect, and no changes or savings for the hospital or
employee would result if they stay with that pln.
Blue Cross pays 80 percent of the bill up to $1 million lifetime.
Out-of-pocket stop loss is $1,500 per employee and $4,500 per family.
The premium is $219 per employee and $279 per family.
Blue Choice is an alternate plan offered by Blue Cross, which would
allow the employee to keep the life insurance policy and dental
insurance. There is a reduction in premiums for both the hospital and
employee.
Health Industry Trust pays 90 percent, with $1,000 stop loss. Life
insurance would be reduced to $15,000 per employee and dental inurance
would cost more. The savings for the hospital is good, but the cost for
child and spouse premiums would increase for employees.
The board will also consider a managed care agreement with Blue
Cross/Blue Choice health management organization, hear a joint
conference committee report and reports from the hospital auxiliary,
medical staff and administrator.
Dr. James Cam, chief of staff, said that practice would be impossible
without assurance that an ICU nurse would be available when a patient
comes into the emergency room very ill.
"We have many, many cases during the year," he said. "We don't need ICU
every day, but on those days we need them, we need to have them."
Patients who are critically ill must be stabilized before they can be
transferred, and sometimes that takes more than a day, he said.
"Would it be acceptable for the board to say leave the ICU intact, but
you would be open if in the future we come up with a solution to your
original proposal?" asked board chairman Raul Garcia.
Dr. Cam said the solution is to get registered nurses who are not
traveling nurses, "and we may have some prospect in that."
Traveling nurses cost the hospital over $100,000 per year, said Jack
Rogers, director of nursing. Two are presently on duty in the ICU, which
requires four RNs.
Getting more doctors in the community would increase the hospital's
chances of getting more RNs on staff, Dr. Cam said.
Chel Flores made the motion to keep ICU open as is, "in the best
interest of the community." Jesse Prieto seconded the motion, and the
vote was unanimous.
Obstetric care has already been reduced to save the use of traveling
nurses, said administrator Bruce Birchell. "It is saving money, but can
we maintain it?" he said. "Down the road it may not work."
The board agreed to hold a workshop at 6 p.m. Tuesday to consider other
means of cutting costs.
Administrator Bruce Birchell reported on several physicians who have
shown an interest in moving to Pecos. Seven prospects had either
accepted another offer, didn't like Pecos or are not available for a
variety of reasons.
Of four new prospects, Birchell said that one practices in Texas, but
would have to take two weeks of training in obstetrics at the hospital's
expense.
Two others from Canada and Egypt are working under special immigration
status and are interested in moving here, he said.
The board approved an employee health insurance plan offered by Blue
Cross that would require the hospital and physicians to join their
preferred provider plan called Blue Choice.
Birchell said the health insurance plan was the choice of employee
representatives. It will save the hospital $24 a month and employees $30
a month for dependents over the Blue Cross plan now in effect.
Blue Cross representative Don Crawford said the Blue Choice plan was
first offered to state employees three years ago, then to metropolitan
areas, large cities, and now to smaller cities like Pecos.
He said that 88 percent of the doctors in Midland and 85 percent in
Odessa have joined the plan.
Pecos physicians will receive information on the plan Thursday and will
be invited to apply, Crawford said. "Then the network can either accept
or reject the provider based on the application."
Most physicians and hospitals are glad to participate because the plan
covers a broad base of state, federal and private business employees, he
said.
Jeannette Alligood's motion to accept the plan provided the hospital and
local physicians enter into an agreement with the PPO was seconded by
Flores and passed unanimously.
Birchell he has negotiated with Blue Choice representatives, and they
are to submit a proposed contract for the board to consider. He said
they agreed on reimbursement based on diagnosis, similar to Medicare
reimbursement, but with a different cost schedule.
Scott Johnson, attorney for the hospital district, said the total
settlement reached as a jury was being chosen for trial was $19,000.
Simms claimed in the 143rd District Court suit that she was passed over
for the nursing director position, and that Jones disbanded numerous
programs that Simms started and changed her work schedule.
The board also adopted a new organizational chrt that moves the rural
health clinic from the nursing director's supervision to direct
supervision by the administrator. Other positions remain unchanged, said
administrator Bruce Birchell.
Birchell said that Medicare has certified the clinic, which is located
in the front hallway of the hospital. Michelle Cser is the physician
assistant who sees patients under the supervision of Dr. Orville Cerna.
A physician assistant is a health professional, a member of the medical
team that cares for patients in all areas of medicine along with the
doctor, nurse, medical assistant and others.
Under Cerna's direction, Cser may perform full patient workups, order
diagnostic tests and laboratory exams and make a diagnosis. She consults
with Dr. Cerna before treatment is carried out.
Birchell reported that a young female physician will visit Pecos this
weekend to look over the hospital and decide if she wants to practice
here upon completion of residency requirements in June.
She is foreign born and would be a candidate for J-1 Visa status, he
said. The U.S. Department of Agriculture has changed the rules to force
such doctors to practice in rural areas, Birchell said.
Hospital employees will be covered by Blue Choice health insurance as of
May 1.
The Honeywell energy audit shows a savings of $11,000 for the last six
months of 1994, Birchell said. "They are committed to save $14,000 in a
year. In a hotter time of year, the savings may be more apparent."
Dr. W.J. Bang reported that laboratory inspectors last week found only
three minor deficiencies.
"It was very successful. Two years ago we had a 54-page writeup on
deficiencies," he said. "I give credit to Elizabeth Pante and all the
staff."
Board chairman Raul Garcia said that numerous deficiences have existed
for several years.
"Several times we came close to being shut down. This is a tremendous
thing done by lab personnel," he said.
Birchell said the respiratory therapy inspection resulted in no
recommendations. "The inspector was very pleased. Everyone did a good
job," he said.
Leo Hung reported that the Reeves County Health Fair Saturday had 750
registered participants plus others who did not register.
"We thank the board for your support and allowing us to use this
beautiful facility and let the public know we have a beautiful
hospital," he said.
The fair was begun eight years ago to promote health and the hospital,
he said.
Co-chairman Linda Gholson said the fair committee will meet next week to
evaluate the results and see what needs to be changed or added next year.
She asked the board to approve use of the hospital for early April 1996,
and they agreed.
"I don't have any problem with that," Garcia said. "It was a double
blessing. People are allowed to show what they have, and the hospital
profits from the experience. I think it is a beautiful opportunity."
Chel Flores commended the committee for doing a fine job. "All the
comments I received was positive," he said. "Everyone enjoyed it."
Gholson said all the work is done by volunteers, and that anyone who
wants to help is invited to join the committee. "It is a big commitment
for a lot of people," she said.
Birchell said that some people were disappointed when they arrived at 1
p.m. to have their blood drawn for testing and learned that they were
too late. The blood samples must be shipped by bus to a lab, so the
booth is shut down at 12 noon, he said.
Guidelines for the Forgiveness Loan Program were referred to the
committee for review and recommendations on changing. Jeannette Alligood
had requested the guidelines changes already made be submitted to the
board for approval. She was not present at Tuesday's meeting.
Garcia reminded board members of a special meeting at noon Thursday to
consider refunding revenue bonds. They previously discussed extending
the payout two years to avoid making a large payment May 1.
Elizabeth Pante, laboratory technician for Reeves County Hospital, said
she has a good supply on hand and has been promised continued delivery.
"They told me last night they are still going to supply us blood from
other centers," she said. "But they won't be accepting donations."
Directors for the center, which is jointly owned by Midland Memorial
Hospital and Odessa Medical Center, forced the resignation of executive
director Dan Spinuzzi and appointed a "Quality Improvement Team" charged
with conducting an internal review of the facility, said Sanzs.
After the board decided Wedensday to voluntarily suspend collection and
processing of blood, the U.S. Food and Drug Administration officially
suspended their license on Thursday, he said.
"We are taking care of this problem in the most expedient manner we can
to ensure a safe and reliable blood supply for the Permian Basin," Sanzs
said.
He said the board initiated an investigation of the center after a
routine inspection by the FDA in which a number of deficiencies were
noted.
"In response, we hired a respected national independent consulting firm
with experience in FDA compliance issues," Sanzs said.
The Quality Improvement Team, composed of officials not related to blood
center operations, interviewed each employee in regard to FDA
observations and other concerns, he said.
"With this information presented to the board Wednesday, the decision
was made to voluntarily suspend collection and processing of blood
products on a temporary basis," he said.
Dr. Morgan Dyer, PBRBC medical director, said allegations that the blood
supply is not safe are unfounded.
"Each blood product issued by PBRBC is subjected to rigorous testing by
a third party, and all blood products we have distrubuted have tested
safe," he said.
Permian Basin residents should rest assured there will be an adequate
supply of blood for patients, he said.
PBRBC will receive 400 units of blood from other agencies this afternoon.
Sanzs said the center has 30 days to respond to the FDA's notice of
suspension with a program to address deficiencies. The board and staff
will aggressively pursue corrective action, and the center is expected
to resume full operations in compliance with all FDS regulations in a
"very timely manner," he said.
Dr. Chris Hall, former medical director, has been named interim
executive director.
That provision conflicts with two items requiring funding to cover only
the last two years of the program and that the student must be accepted
by a program prior to receiving assistance, said administrator Bruce
Birchell.
However, Birchell said that the need for registered nurses is so great
that he feels the extra incentive may encourage licensed vocational
nurses to continue their education.
Other health care professionals are eligible for the program, as well.
It provides up to $500 for books and tuition per semester the student is
enrolled in college. Another $400 is available for travel and living
expenses, because most students study in Odessa, Birchell said.
The applicant must sign an agreement to work at Reeves County Hospital
for at least six months for each semester funded after completing his or
her education. However, Birchell said that so far no one has completed
training.
He said the provisions that funding would be for the last two years of
the program and that a student must be accepted by a program prior to
receiving any assistance would eliminate some of the candidates who have
washed out of the program.
The applicant should demonstrate ties to the community, and preference
is given to hospital employees who have a good work record and
satisfactory evaluations.
While in school he or she should maintain a 2.5 grade point average.
Board chairman Raul Garcia, who is a member of the educational
assistance committee, said the committee has discretion to deviate from
the guidelines in pproving applicants.
"I don't see where (giving consideration to hospital employees enrolled
in prerequisite courses) will tie the hands of the committee one way or
the other," he said.
Jeannette Alligood said that employees may be encouraged by that
provision to go ahead and do prerequisite work. "Not getting help in the
first two years could stop them," she said.
Birchell said it is worth the risk, "considering the need for RNs here.
In talking to LVNs, they thought maybe prerequisite work should qualify."
In other business, the board took no action on a managed care proposal
by Foundation Health on Birchell's recommendation that it not be
approved because the rates are too low.
They referred a similar proposal from Methodist Hospital in Lubbock to
Birchell for negotiation of rates in specific areas where he thought
they, too, were too low.
Birchell said he is most concerned about reimbursement for one-day
admissions, which he said is below cost.
Ray Mason, vice president for community and physician relations, said
that Methodist Hospital wants to help its affiliates, and "We will be
reviewing rates in the next few months to see if they need adjustment."
"If there's one or two in here you can't live with, call Mrs. Reed and
say, `Our costs are so much, and we can't stand that,'" he said.
Mason showed a videotape explaining how Methodist Hospital works with
affiliated hospitals, outreach centers and family clinics in a regional
network.
William D. Poteet III, president and CEO, said the network's purpose is
to keep health care local, serving the local community, and offering
resources for the staff.
"We offer resources with our entire system for a community to build a
health care system they want and need," he said.
Area affiliates described in the tape are located in Levelland,
Brownfield and Lovington, N.M.
Mason said that Methodist Hospital plans an advertising campaign in the
next two months to enroll companies in the plan.
"We are working with some major insurance companies representing 65
percent of the market in West Texas," he said.
Finance officer Mike Hathorn reported that the hospital census was up in
March, and "we achieved the budget." Low bad debts for the second month
helped, he said.
Upon completion of the Cost Report, Hathorn said he found that Medicare
owes the hospital $23,737, and Medicaid owes $271,186. He sent a letter
with the report asking for an expedient settlement, he said.
Blue Cross has admitted making a mistake in prior years payments, which
caused discrepancy in Medicare and Medicaid reimbursements, and the
hospital will also benefit from that.
Bills totaling $334,995 were approved "as money becomes available."
Birchell said he checked with the state comptroller's office about a
discrepancy in the sales tax rebate for April, which was low. He said
that an overpayment made in January was deducted from the April rebate.
"We didn't get shortchanged," he said. "We just got it early."
Since the Permian Basin Regional Blood Center lost their license to
collect and process blood, Reeves County Hospital returned the supply on
hand and received blood processed in other centers, Birchell said.
Permian Basin hopes to resume collecting blood in about 60 days, he
said. In the meantime, there will be no blood drives in the area, he
said.
"I don't know if it will make a shortage in the next 60 days," Birchell
said. "It might. We do have safe blood coming from appropriate sources."
He said that a Medicare survey of the emergency room following a
complaint triggered some deficiences.
"The staff was in-serviced very heavily on what to do," he said. "We had
a surprise inspection, and we passed and were cleared."
A minor deficiency in the Rural Health Clinic was also cleared, he said.
The clinic is averaging 15 patients per day, which is capacity, he said.
Nursing director Jack Rogers has resigned as of May 5 to move to Big
Spring, Birchell said. "We are looking for an internal candidate to be
interim and possibly permanent."
Physician recruiting is not going well, he said. Despite hard work by
recruiting agencies and his own contacts with friends of doctors,
candidates are few, he said.
One doctor who visited Pecos last weekend was "fairly interested," he
said.
Most of those who show an interest are older physicians who are being
squeezed out of their solo practice by managed care or are foreign-born
students who are seeking J-1 visa status.
Under current rules of the U.S. Department of Agriculture, which
oversees the work visa program, Pecos qualifies as an underserved area,
he said. But those rules are in the process of being changed.
Two applicants appear to be qualified, but they will not be available
until next year, he said.
"How do we keep Dr. Darpolor from being too stressed out by carrying the
whole load (obstetrics) by himself?" he asked.
"If we bring in a doctor with a temporary license while he is taking the
test, would we have to pay their expenses to move here?" asked Alligood.
"How long would the waiting period be to take the exam?"
Birchell said the next exam is in December. "We could have one here and
licensed within three months. What is the board willing to risk?"
Dr. James Cam, chief of staff, said that students just getting out of
the residency program should be considered for that type of position.
"If you get old ones, they will probably flunk the exam."
Mason said that a nurse midwife could deliver babies under the
supervision of another doctor.
"Darpolor is a very valuable asset to our community, and we need to
support him," Birchell said.
Dr. Cam presented a letter of commendation from the medical staff to
Elizabeth Pante and her laboratory staff for bringing the lab up to
standard and asked the board to write one, as well.
"For the last five years we have had a lot of difficulty; we were almost
shut down. This year, we passed inspection with flying colors," he said.
Iris Rives said that Dr. Cam and the respiratory staff should also be
commended for their inspection with no deficiencies.
"We didn't think about them because we were having so much problem with
the lab," Dr. Cam said. "We were really chewed up by Medicare and CLIA.
There are no problems with respiratory therapy."
He said the lab staff worked late each night on paperwork to correct
deficiences listed in the 52-page inspection report, and they should be
highly commended.
Chairman Raul Garcia said the system would help the administration to
control telephone abuse, in an attempt to make the old system last for
another year.
Dick Alligood of Allcomm Long Distance and Oilfield Phone said he met
with Garcia, administrator Bruce Birchell, maintenance director Pito
Abila and his helper, Noe Orona about the system.
"The equipment is pretty old; it was donated to the hospital when it was
completed," he said. "It has gotten to the point we can't find parts."
With the hospital's poor financial situation, it is not feasible to
replace the system now, so the group discussed maintenance and care,
Alligood said. That would include a school for staff to be trained on
the PBX system and elimination of abuse.
"The facility needs more telephone lines," he said. "You can call out at
times and the lines are busy. We are short two or three lines to ensure
that department heads can get calls in and out."
Project codes would help department heads to see where the usage is, he
said.
"If one particular department is using the phone more than another, the
department head can reduce some of it if it is uncalled for," he said.
"I warn you, we did have this in operation a number of years back, but
we have had so many complaints of people that didn't want to dial the
codes in, the previous administrator requested we remove it. We can put
it back for a trial period."
Not only would the code identify long-distance callers, it would print
out every local outgoing and incoming call, Alligood said.
Marcella Lovett made the motion to install the code system, noting that
it can be removed if it doesn't work out. The vote was unanimous.
The board also approved purchase of a pulse oximeter for the respiratory
therapy department at a cost of $645.
Frank Vasquez said that the department lost the meter it had on an
ambulance transfer to Midland, and they have been borrowing one from the
emergency room. The device monitors oxygen to ensure the patient is
getting enough, he said.
On recommendation by the medical staff, the board approved a change in
the medical staff bylaws to require staff physicians to obtain 48 hours
of continuing education every two years. Current bylaws require 100
hours.
Birchell reported that Jane Raper, whom he appointed interim director of
nursing, will be unable to continue in that position, due to personal
problems. He will seek a replacement.
Dr. Kaiwood Ma visited Pecos in April, but has not made a commitment.
Several J-1 visa candidates are under review, and one of them who does
obstetrics will visit this weekend, Birchell said.
National Hospital Week is next week, and the hospital will host a
pancake breakfast for the staff, physicians, volunteers and board
members on Tuesday.
Garcia presented a letter of commendation to Elizabeth Pante and her
laboratory stff for their outstanding performance during the recent CLIA
survey.
"The survey was the best survey ever received by the hospital," Garcia
said in a letter to the staff.
"The efforts of you and your staff were outstanding. We apprecite your
efforts and urge you to keep up the good work," he said.
Garcia also commended the hospital auxiliary for their work in
furnishing the guest doctors' waiting room.
Maggie Bippes reported the work has been completed and paid for.
"We have 39 members, and all but two or three worked at the health
fair,"
Bippes said.
The board canvassed votes in the May 6 elections and declared Marcella
Lovett and Jeannett Alligood winners. Board secretary Nadine Smith
administered the statement of officer to them following the canvass.
By PEGGY McCRACKEN
Staff Writer
Accountant Dan Painter painted a somber picture of Reeves County
Hospital's finances for 1994 in his audit report to the board of
directors Tuesday.
However, directors were not surprised by the figures, which show a loss
from operations of $2.1 million for the year. Operating revenues
decreased $168,872 from the prior year, while operating expenses
increased $452,364, he said.
"The hospital is hemorrhaging from decreasing revenues, increasing
expenses and budgets that are not met," he said.
Last year's loss of three physicians triggered the financial problems,
he said.
"The ever-present fragile environment of a low patient census, large
uncollected accounts receivable coupled with an increase in bad-debt
writeoffs and over-spent budgets was further aggravated with the
physicians' departure," Painter said.
Boad members and administrators have been working to correct those
problems, interviewing prospective physicians and cutting expenses.
Salaries and wages continued to rise as the census dropped. The board
earlier this year considered closing the intensive care unit and
streamlining the nursing force. That plan was rejected after the board
met with staff members in a workshop setting.
Hospital admissions have been unusually high for the spring, and
revenues are up, said Mike Hathorn, finance officer, but "we still have
a loss from operations."
Administrator Bruce Birchell said that Dr. Kai-wood Ma has expressed
interest in relocating to Pecos, and contract terms are under
negotiation.
Dr. Nicholas Gajic visited the hospital lst weekend and he is also
interested, Birchell said. Both would require work visas, as they are
foreign-born.
Dr. Kai-wood Ma agreed to six weeks of obstetric training, with the
hospital paying $7,500 in expenses and stipend. His income guarantee
would be $140,000.
Ray Mason, representing Lubbock Methodist Hospital, said the board asked
them to perform an operational audit, which was completed last week. The
board agreed to meet at 6 p.m. Tuesday to hear the report and any
proposals Lubbock Methodist has to continue affiliation with RCH.
Birchell introduced Sheila Apps, the new interim director of nursing.
Apps said she was trained in England and worked in Canada for 20 years.
She has been in Pecos three months, and "I am trying to learn this
system."
Reeves County Clerk Dianne Florez administered the oath of office to
Jeannette Alligood and Marcella Lovett, who were re-elected May 6.
Jesse Prieto nominated Raul Garcia for board chairman, and Garcia
nominated Prieto for vice-chairman. They were elected without opposition.
On recommendation by the medical staff, the board amended the medical
staff bylaws to reduce continuing education hours for staff dentists
from 50 hours every two years to 24 hours every two years, and approved
staff privileges for Gary Albertson, D.O. and Anthony Sforza, M.D.
Following an executive session to evaluate Birchell, the board took no
action.
Riley is employed by Quorum Health Resources, the management contractor.
She replaces Bruce Birchell, who is on extended medical leave.
In Tuesday's board meeting, Jim Bullard, community services
representative for Lubbock Methodist Hospital System, presented results
of an operations audit they performed recently as part of their
affiliation agreement.
High on the list of recommendations is developing new sources of
revenue. Riley said that is her first priority, along with physician
recruitment.
"With this being a tax-supported institution, no one wants to raise
taxes, and the hospital needs to run as efficiently as they can," she
said.
Bullard recommends establishing a hospital-based home health agency as
one means of increasing revenue.
The board had previously approved such an agency, but its competition
with Leo Hung's American Home Health Agency and a lack of support by the
nursing staff left it adrift.
Staffing, cross-training and salary structure are personnel matters that
need to be addressed to cut expenses, Bullard said. He noted the current
employee structure is top heavy and staffed with too many departmental
assistants.
Board chairman Raul Garcia said he agrees. "We have too many people
making big salaries," he said.
Garcia said a productivity study to determine the number of hours worked
and personnel necessary to handle current and future patient loads is a
priority.
Also important are reviews of the contract for pharmacy and other
services, organizational structure for accounting, medical records and
business office, and coding procedures to guarantee that the maximum
amount of revenue is being collected per procedure, he said.
Mike Hathorn, chief finance officer, said he believes the business
office and accounting structure are working well.
The recommendations, he said, reinforce those made to the board by
Quorum and the administrative staff. Some of those recommendations were
adopted, but the board balked at closing the intensive care unit and
cutting nursing positions.
Riley said she believes she can work well with the board and medical
staff.
"I am pleased to be here, and I think there are a lot of opportunities
at the hospital," she said.
She transferred from Chamberlain, S.D., where she was chief executive
officer of a 54-bed acute care private hospital operated by Quorum. When
that contract was terminated, Riley became available for the interim
position.
During her two-year term there, Riley actively recruited physicians,
rebuilding the medical staff in a volatile political climate. She
implemented a public relations program and community involvement to
counter the boycott of two physicians and successfully defended the
hospital from predatory advances by a nearby tertiary facility.
Impressed with Reeves County Hospital, Riley said, "The community should
be glad to have a hospital of this caliber."
Copyright 1996 Pecos Enterprise
324 S. Cedar, Box 2057, Pecos TX 79772
Phone 915-445-5475, FAX 915-445-4321
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