Modoc County Grand Jury Fy 2006-2007 Report This report, past reports and responses, and other Grand

Commendations 4

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  (cid:1) To those who continue to provide patients and their families with often life-saving quality compassionate and professional care, including the auxiliary that has steadfastly worked to make difficult life circumstances more bearable for patients and families. (cid:1) To those who maintain the facilities and keep them in a clean and safe condition. (cid:1) To management for pursuing payments that provide reimbursement for actual cost of patient care (Critical Access Hospital status). (cid:1) To management for pursuing and completing a contract with the Veterans Administration to house and care for disabled and aging veterans.
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  Communications with the Community Communications between MMC and the community it serves was identified by MMC (CEO), as the most significant issue facing the success and future of MMC. The BOS Chairman also stressed that providing information to the public and opening full lines of communication is critical to the continuation of MMC. Methods used by MMC to let the public know of activities and professional services available include the newsletter “Careline” and website at www.modocmedicalcenter.com. MMC has also provided news items and advertisements to the two local newspapers and hosted public meeting(s). The monthly 2nd Tuesday meeting of the BOS deals with MMC business and provides another opportunity for the public to gather information. Though difficult to assess, consensus of the MMC CEO and MCR Editor is that written information may be provided to the reading public but does not generate productive criticism or response by the general community. It was suggested by those interviewed that the most successful, and often damaging, method of communication, is word of mouth. The MMC CEO and the BOS Chairman have indicated that some of the most damaging publicity has come directly from employees and former employees. If that is the case, the reverse would also seem to be true – that employees and former employees can become one of the most effective sources of supportive publicity. The MMC CEO stated during an interview that his door is open and comments from the community are welcomed, as any organization needs to know the good and the bad in order to improve. The MMC CEO also indicated that MMC has conducted an employee survey to identify areas that work well and areas in which improvement is needed. In spite of the policies of openness, the publicity MMC as an organization receives, whether published or passed on by word-of-mouth, is almost entirely negative. Tied to communications is the effort of MMC to reclaim patients who have chosen other facilities for whatever reason. Some progress has been made in this area. As of 2006 patient numbers were down 25% over the previous year; however, this year has shown a 6% recovery. The MMC administration sees the loss of patients largely as a result of the loss of key medical staff and general confidence. Continued operation of MMC The BOS has contracted with Chico State for a study to determine what economic impact the community and County could expect should MMC close its doors. Information on the pending study was shared by the BOS Chairman during interview and underlines how serious the MMC issues really are. The hospital debt, held by the County, is approaching $8 million as of this writing. The BOS Chairman indicated that the debt is not the only consideration in the future of MMC; however, it certainly is significant relative to decisions that must be made. More specific information about this debt is provided in the Audit and Finance section of this report. According to the State of California 2006 report of small and rural hospitals, MMC is one of only three medical facilities in the State that continue to be operated by a County. As of the interview with BOS Chairman on June 5, 2007, MMC is now the only County-owned/operated small, rural facility. One of the previous two is now operated as a district and the other closed its doors in 2007. All other small, rural hospitals in California are either privately owned, non- profit, or operated as districts, such as the Surprise Valley and Fall River facilities. The Trinity County BOS presented hospital district information to the Modoc County BOS, after having gone through that process in Trinity County very recently. In order to set up a hospital district the following are some of the things that must take place: Create a special district (ex. Recreation district voted on recently)
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  Identify district boundaries and services Determine tax assessment Get voter approval for the district and tax assessment At the present time 37% of the population using MMC is Medi-Cal/Medicare patients. The average in California is 19%. Additionally, MMC supports about $400,000 every year in non- paying patients. Although the Critical Access Hospital payment system, for which MMC is making application, will provide a greater reimbursement, a short-fall in payments versus costs is still expected. As a district, MMC would receive tax funds at a rate estimated to cover the short- fall. The hospital, clinic and senior nursing facility, are operated by the County as a single MMC entity and would presumably continue to be managed together. Voting for a district is expected to come as soon as the November 2008 elections, according to both MMC CEO and BOS Chairman. Facilities Seismic retrofit of the MMC buildings, that is construction or reconstruction of facilities to meet the State earthquake code, is being delayed as provided by State law. As long as MMC remains open, the delay to make the required retrofit by 2013 will remain in effect. It is possible the delay can be extended to 2030. In the mean time a determination of seismic hazard specific to Modoc County may provide some relief in meeting code appropriate to this area rather than a standard applicable to facilities located in known high hazard areas. Substantial retrofit requiring construction or reconstruction applies almost entirely to the older acute care hospital. Should the facilities close for any reason, the delay would no longer apply and reopening the facilities would require immediate upgrade to State code. This must be given serious consideration in deciding the future of MMC. MMC has undertaken various cosmetic improvements throughout the past year. When asked about the expenditure of funds for cosmetic purposes rather than spending funds on something more substantial, it was noted that, while cosmetics may not be long-lasting or add to the quality or breadth of services provided, it is important in terms of recruiting professional medical staff and for the comfort and confidence of patients. The single issue in implementing reconstruction or construction to comply with State code standards is, of course, funding, and as long as the hospital remains open is not of imminent consequence. Technology The most pressing technological need identified by MMC management is the acquisition of a CT scanner. This is considered an essential piece of equipment for accurate diagnostic services. This is particularly true for emergency evaluation and transfer decisions. MMC CEO has indicated the cost of this equipment is estimated at some $300,000. MMC has access to telemedicine. However, as is well known, constant progress in technology makes it virtually essential to keep pace with the best provided. Software has and will continue to be purchased in order to keep up with the needs of patients, human resource and financial management. Human Resource Human resource management is identified as an issue because of public comments received by Grand Jury members, as a follow-up to the 2005-2006 Grand Jury report, and as a subject of local conversation. Both the MMC CEO and BOS Chairman recognized in interviews that the morale of the MMC workforce in general and as individual employees, plays a role in how MMC is perceived by the community. MMC and BOS awareness of the state of the workforce is
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  indicated in interview statements acknowledging the impact that unhappy, “disgruntled” current and former employees can have on the reputation of MMC. Issues identified in public comments and the 2005-2006 report include the treatment of employees at time of dismissal, employee fear of reprisal, and inclusion of volunteers in the decision-making process. No illegal activities have been identified to date but there is ample room to question the ethical and political soundness of some administrative actions in the manner of dismissal, the use of volunteer(s) in matters of employee and patient confidentiality, and the use of volunteer(s) in any capacity normally reserved for upper management.

No Responses Found 2

Government entities assigned to respond to this report. No response documents have been linked in our database.