Wednesday, December 18, 2013
BREWSTER Three Rivers Hospital commissioners selected a course of action Monday to cut costs, but not before the physicians called for the head administrator’s resignation.
Dr. James Lamberton read a letter, signed by all the physicians that work with the hospital, which cited a lack of trust in the board and in Chief Executive Officer Bud Hufnagel.
“Unfortunately, his leadership style has created a sense of uneasiness and at times literal fear within the staff of the hospital,” Lamberton said. “In spite of working in an environment of what I would consider fear and intimidation, this core group of people continues to provide excellent care for our patients.”
“We feel that the hospital is definitely in peril due to the lack of positive leadership,” he said. “We do not believe that the current administration is acting on our behalf.”
To shore up the hospital’s financial situation, the board selected a course of action that calls for cutting about 16 positions.
The hospital’s plan also called for discontinuing the cardiopulmonary rehabilitation department, as well as Healthbeat Fitness Center and Advantage Durable Medical Equipment. It would reduce hours for respiratory therapy to Monday through Friday and end after-hours surgeries other than emergency Cesarean sections.
This option estimates a net income of $422,349 next year.
“Boy, I find that (cutting positions) hard to do. That’s a big mistake, that’s 16 people and the families that belong with them,” Commissioner Jerry Tretwold said.
Controller Jennifer Munson said 10-12 employees have already left through attrition.
“Tomorrow, there are not going to be 16 pink slips going out,” she said.
One of those leaving is Chief Financial Officer Bomi Bharucha, who was hired last year on a temporary basis. The position won’t be refilled, Hufnagel said.
Munson, who once served as the chief financial officer, will continue to oversee the hospital’s finances.
Hufnagel didn’t respond to the call for his resignation, but board Chairman Dan Webster extended gratitude to him for his work since arriving in fall 2011.
“When Bud Hufnagel stepped into the door here and agreed to take this position, he stepped into a mess,” Webster said. “Bud has sifted through a lot of scenarios and has sifted through a lot of work to get this place on track, and I commend Bud for his sincere efforts all the way.”
The board followed Lamberton’s statements with a vote, at the urging of Tretwold, to keep obstetrics as the “cornerstone” of the hospital’s services.
All but one of six options presented at the Nov. 25 meeting would have eliminated the department, and doctors and community members publicly protested the idea.
However, Tretwold’s motion also would have postponed a decision on either of the options presented until the board could more thoroughly review each department. It was met with some resistance from other board members when he asked that obstetrics be spared throughout the next year and into the future.
“We do a lot of great things in this hospital,” Tretwold said. “I believe we can turn this around.”
“We can’t guarantee what this hospital is going to look like next year at this exact same time. There are budget cuts all across the line – federal, county, taking away money from us,” said Commissioner Vicki Orford, who will serve as the board chairwoman next year. “I won’t second it (the motion), and I will oppose it. I’m sorry.”
Commissioner Mike Pruett added the caveat to review obstetrics every six months, and the measure passed unanimously.
Hufnagel said the hospital will not be able to bill for cardiopulmonary rehabilitation after Jan. 1.
Three Rivers is talking with Confluence Health of Wenatchee to possibly reach an agreement that would keep the service open in Brewster, he said, and a bill is sitting in Congress that could make an exception for rural hospitals.
Pruett suggested approving that option, but keeping cardiopulmonary rehabilitation and reviewing it after the first of the year to see where the law ends up. His motion also passed unanimously.
Spokeswoman Rebecca Meadows said cardio rehab had a gross margin loss of $85,859 over the past 11 months. Healthbeat lost $45,099 and Advantage lost $47,177.
Advantage Manager Bennie Polvos plans to work with the hospital to purchase the latter two in order to keep them both operating in the community.
Hufnagel said the six options presented at the Nov. 25 meeting were not staff recommendations.
“What we were chartered with from the board was to review all the areas the hospital is associated with … and come up with a combination of scenarios that would allow us to keep the most services and try to get to a point where we could make money doing that,” he said.
Hufnagel said nobody wants to cut services.
“It wasn’t about whether or not we wanted to do something, it was about whether or not we’re going to be able to do something,” he said.
“I don’t think we are tearing down this hospital,” Orford said. “I think we are making the changes that are necessary to keep it here. These are hard decisions. We don’t like them; nobody likes them, but we’re going to have to make them.”
In addition to the requested resignation, the doctors’ letter asked the hospital to change its direction by Jan. 1 to positive planning as opposed to cutting; set an emergency meeting of the medical staff strategic planning committee by Jan. 21; share full disclosure of all finances used in decision-making; stop eliminating services until a new strategic plan is in place; call in an outside auditor to review finances by Jan. 15; and develop a community advisory committee, including representation from the Hispanic community.
Before the commissioners voted, Lamberton pleaded with them “to be a part of building, rather than tearing down one of the greatest assets a rural community can have – a hospital.
“As we move forward, this needs to be a time of reconciliation,” he said. “We need to join hands and come together in a sense of community.”
He commended the board for its service and said Hufnagel has been “effective” in cutting services and employees, some of them needed, but expressed concern that physicians and staff are leaving the area.
When audience members asked if the board would address the physicians’ letter, they took a vote on the options presented.
“They (the commissioners) took Option 2, so that was how they addressed the letter,” Meadows said.
Rob Lamberton, who works along with Dr. James Lamberton in Caribou Trail Orthopedics, questioned the decision to cut hours in the surgical department.
He said restricting hours for surgeries wouldn’t work for already overloaded orthopedics staff, and expressed concern that patients going elsewhere would take revenue away from the hospital.
“There’s a lot of benefit from having that service here, and I don’t understand how it has been eliminated so quickly,” he said.
Hufnagel said the hospital has committed to allowing Dr. James Lamberton to keep his block scheduling, but the volume of after-hours surgeries wasn’t enough to keep that service going.
“The fundamental thing we have to do as a critical access hospital is stabilize the ship,” he said.
Some residents commented at the end of the meeting. Roger St. Clair asked that the hospital research the best possible options and include doctors in planning going forward.
Millie Arellano said she has chosen to go elsewhere as an obstetrics patient because several physicians have left, stretching the remaining doctors thin.
“I want to see this hospital be here for my great-grandchildren. It’s a great place,” John Kirk said.
Human Resources Director Anita Fisk later approached the board with a request from a small group of employees that the employer contribution for retirement plans be cut, even temporarily, to avoid any layoffs.
The board, however, had already voted to accept Option 2. All the commissioners agreed to leave the contribution as-is.