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VAN DYKE -- A loan for a newly graduated
physician from the area who is beginning a three year residency in
family practice medicine, the sale of the old DeLeon Nursing Home
building, a charge that the hospital violated a medical privacy law
and authorization for an initial investigation of a new construction
project at the hospital campus were among the more notable topics in a
busy directors meeting at Comanche County Medical Center (CCMC) last
week.
The Board of the Comanche County
Consolidated Hospital District met in regular session on Tuesday, June
27, following a noon public hearing on the District's budget for the
coming fiscal year. All Board members were eventually present at the
meeting.
Budget Hearing
The proposed budget for the fiscal year
beginning July 1, 2006, and ending June 30, 2007, was presented and
explained by Chief Executive Officer Evan Moore and Chief Financial
Officer Pam Rice.
The proposed budget contains no provision
for a property tax rate increase, although a 5% increase in property
tax revenue was projected due to increased taxable valuations. The
budget includes an increase in staffing of almost 11 full time
equivalent personnel. Areas targeted for personnel increases include
nursing, ambulance and home services.
Hospital room charges are budgeted to
increase by 5%. The budget also projects a restart of the primary home
care department, which had earlier been discontinued.
Overall salaries and benefits are
budgeted to increase by more than $571,000, including the cost of the
additional personnel and a 2.25% merit and cost of living increase,
and partially offset by a planned 15% decrease in overtime pay due to
increased staffing levels.
The proposed budget includes a 3.3%
increase in discharges of acute patients and a 1.6% increase in the
average daily census of acute patients. The budget also includes
increases of 11.8% for swingbed (non-acute) patients and an increase
of 8.4% in the swingbed average daily census. Patient visits at the
clinic and emergency room visits are projected to remain at current
levels.
Directors John Mack Weaver and Charles
Mazurek both expressed concern over the projected increases in
staffing.
Provision for $269,000 in capital
expenditures is also included. The largest two capital expenditure
items were $85,000 for a new ambulance and $50,000 for various
computer equipment. There was considerable discussion regarding
various capital needs. It was noted that approval of the budget was
not an automatic approval of the capital items included therein.
The earnings projected for the new
hospital's second complete year of operations is $184,000.
In response to a question from the Free
Press, CFO Pam Rice said she had not made a comparison of the proposed
budget to the financial projections prepared prior to construction of
the hospital, although she expressed her desire to do so. CEO Evan
Moore expressed his belief that the hospital was attaining the
improvements in personnel efficiency included in the earlier
projections.
Following the conclusion of discussion on
the budget, Board president Charles Mazurek declared the budget
hearing closed and received a motion by Mary Jane Atkins to approve
the fiscal year 2007 budget. Karen Carr seconded and the budget was
unanimously approved.
Medical Staff Report
Dr. David Long, outgoing Chief of Staff,
discussed changes in the officers of the CCMC medical staff including
the Director of Laboratory Services and changes in physician staffing
for the Emergency Room.
Chief Operating Officer Mike Hare noted
that July 28 would be Dr. Long's last day of service at CCMC. The
hospital plans to hold an appreciation and goodbye party on the last
Sunday afternoon in July at the First Methodist Church's Heritage
Hall.
Moore and Hare then discussed with the
Board a proposed arrangement to loan $50,000 over 36 months to Ruth
Reeves, D.O., a recent medical graduate who grew up in Gorman and is
currently accepted to the family practice residency at John Peter
Smith Hospital in Fort Worth.
The loan would be considered to be repaid
in full if Dr. Reeves practiced for as long as three years on the
staff at CCMC. If she did not end up coming here to practice, the
terms of the loan would call for repayment with interest over a
relatively short period of time.
Joe Locke said he had met Dr. Reeves and
was impressed with her. He recommended that the Board approve the
administration's proposal. It was noted that DeLeon Hospital had
earlier used similar arrangements in enticing new physicians to the
area.
After brief discussion, Locke made a
motion to approve the proposal and give the administration the
authority to negotiate and execute the agreement. Karen Carr seconded.
The vote to approve was unanimous.
QI/Compliance Report
Gale Easley reported to the Board that
most things discussed in the earlier committee meeting were good and
no Board report was needed. Two matters did need to be reported,
however.
One was a copyright infringement matter
regarding an unauthorized copy of materials that were provided to a
third party. Easley said the matter had been straightened out and that
the company involved was very nice about it. "That's no big deal," was
her conclusion.
Easley also reported that a HIPPA (Health
Insurance Privacy and Portability Act) compliance issue had arisen.
She said the matter is being looked into and that measures have been
taken with the staff member involved. She concluded, "Of course,
that's a serious compliance issue, and I wanted to make sure the Board
was aware of that being out there."
Joe Locke, the second Board
representative on the QI/Compliance committee, noted that a
re-education process needed to be started regarding the requirements
of HIPPA.
Evan Moore added that a call had been
received from the Office of Civil Rights regarding an alleged civil
rights violation that he suspected had some relation to the HIPPA
compliance problem.
Easley said the Board needed to be aware
of the violation because everyone at the hospital and clinic will be
particularly vigilant in complying with the HIPPA requirements, and
that complaints may arise when medical test results and records are
not released to a spouse or other relation if the proper release
documents have not previously been signed by the patient. "It's going
to cause some inconvenience, and we're going to have some people mad,"
was how she put it.
Moore noted that the records release
involved in the subject incident was based on a fabricated request.
"It was an illegal request," he said.
In response to questioning by John Mack
Weaver, Moore said that the illegal request was what led to the
violation. Weaver suggested that the illegal request should be
reported to law enforcement authorities.
Moore said they expected to hear from the
Office of Civil Rights in the following week and said he couldn't go
into any further details in an open meeting. Weaver persisted in his
insistence that the illegal request be pursued.
Easley noted that even though the illegal
request may have prompted the violation, the hospital still didn't
handle things entirely correctly, and that was her concern as a Board
member.
The hospital's response in terms of
increased employee training was discussed. Moore noted that the
subject was so broad and exhaustively regulated that it was impossible
to have every employee trained in every aspect. He noted that there
are around 20,000 pages of Medicare regulations on the Act relating to
hospitals.
Moore noted that no official notice of
violation nor claim has yet been received, nor has the hospital's
legal counsel been involved, other than relating to the punitive
action taken regarding the employee involved.
Sale of Nursing Home Building
 Evan
Moore reported that the hospital has a contract for purchase of the
now closed nursing home property and that it is currently being
reviewed. He noted that the Board had earlier given the administration
authority to dispose of the property, however, he wished to bring the
matter before the Board again for further assurance.
Moore said, "The main question was the
usage of the building, and they did stipulate in the contract that
they wanted the blessings of the community of DeLeon, or would like
that, to bring the services in there. They are talking about rehab
services. We have talked with them about mental health rehabilitation
services."
Moore also commented that the hospital
had discussed cooperative use of certain hospital employees and said
that the hospital had previously been offered a contract by MHMR out
of Brownwood for providing mental rehab services.
Moore said a price of $62,000 for the
building and parking lot had been negotiated. He said the buyer
reserves the right to terminate the contract if the City of DeLeon
does not approve the treatment center.
Gale Easley offered a motion to approve
execution of the contract, seconded by Karen Carr, and the affirmative
vote was unanimous.
Nursing Department Report
Chief Nursing Officer Shannon Steigleder
reported on staffing and management in the various sections of the
Nursing Department. She told about a HIPPA compliance training program
that she had developed that nurses were required to read and be tested
on. She noted that morale in the department is better.
Steigleder reported that several cases of
Avian Flu had recently been documented overseas where human-to-human
transmission had been verified. She added that although the disease
was not here, it could be here by next year. Evan Moore added that the
death rate for the flu is higher than 50%.
EMS Report
Danny Owen reported on the activity and
conditions in the Emergency Medical Services department. He noted that
his department is stretched very thin in staffing. "We have a lot of
people kind've burning the candle at both ends," Owen stated in regard
to those who work on call-in's during their scheduled off-hours.
Owen added that recruiting for EMS was
difficult in rural areas. He said that the state's licensing and
degree programs were making it more difficult to get EMS technicians
as well.
Owen stated that the EMS department is
averaging over 4,000 miles per month in emergency mileage, not total
mileage, as it serves the county. He added that it is difficult to
provide rapid service to parts of the county due to limited crossroads
in the middle of the county.
Administrative Report
Evan Moore led the Board through a
lengthy comparison and discussion of two quotes for liability
insurance for the hospital. At the conclusion, a motion was made by
John Weaver to accept one of the two quotes, it was seconded by Joe
Locke and unanimously approved, all despite the matter not being on
the meeting agenda.
Mike Hare then led the Board through a
second, shorter comparison and discussion of two property insurance
quotes, also concluded by a motion, second and unanimous vote, again
on a matter that was not on the agenda.
During the discussion, Joe Locke
suggested that the replacement values on the hospital building should
be increased by at least 15% due to inflation in construction costs.
Moore stated that the final walkthrough
and inspection of the hospital building for any remaining construction
warranty issues would take place on the following day. "It will be
ours after tomorrow, no warranty," he stated.
New Construction Proposal
Moore informed the Board that he had been
approached by Brad Bettis to look at constructing a new building on
the hospital site to house physical therapy. This would allow all of
Bettis' outpatient physical therapy to be performed adjacent to the
hospital.
Moore continued that a new building could
also house pain management therapy and create room for nuclear stress
testing at the hospital. Daycare facilities for hospital employees was
also mentioned as a possible use for a new building, as well as
facilities for on-call emergency room staff.
The prospect generated many questions and
discussion by both Board members and staff. John Mack Weaver noted
that the Board had previously encouraged Evan and Mike to look at new
services the hospital could offer. Shannon Steigleder discussed the
operations of a daycare center located at the previous hospital where
she worked, as well as the difficulty in locating daycare services in
the area.
Moore emphasized the potential structure
discussed would be an entirely separate structure apart from the
hospital. He said that Bettis had indicated that he would be
interested in being at least a partial partner in the new building.
Moore reviewed the hospital's current
arrangements with Bettis for inpatient physical therapy and how well
he believed it was working. He noted that most hospitals have to hire
a physical therapist or hire a contracting company to provide
inpatient physical therapy services, and that often they end up losing
money on the service. At CCMC with the arrangements with Bettis, Moore
stated, "We are guaranteed to never lose any money, and almost always
guaranteed to make a little. It's one of the premier (physical
therapy) arrangements in the State of Texas, from everybody I've
talked with about it."
Moore indicated that the particulars of
the arrangements would have to be studied, but that he believed that
any building located on the hospital site should be owned by the
hospital.
Board president Charles Mazurek indicated
he thought it was "worth a look." He asked if it were the consensus of
the Board to look at the prospect and received affirmative responses.
Moore indicated he would investigate the matter and report back to the
Board.
Mike Hare said that May was a good month
for surgeries and total revenue, despite the average census of 19.0
being below the budget of 24 and the April average of 19.4.
Hare reviewed some operational statistics
from the Hospice Department, presented some letters of thanks and
bragged on the operation.
Pam Rice noted that due to her hard work
on the budget that she did not have April financial statements for the
Board to review. She did point to May being another good month of cash
exceeding its target and noted that the hospital had approximately
$775,000 in cash reserves as it goes into the summer months, a more
favorable position than normal.
Rice also discussed sending out pre-bid
depository bank questionnaires and the three results. After an
invitation for bids was sent to the responding banks, two bids were
returned.
After discussion of the two differing
bids, Rice recommended that the hospital remain with Comanche National
Bank for the next two years. Gale Easley made a motion to accept
Rice's recommendation, Karen Carr seconded and the motion was
unanimously approved. |
