Commissioners to look for cause to fire hospital CEO

Revelations and rancor dominated a two-and-a-half-hour hospital commission meeting that culminated with steps taken toward the possible ouster of Coulee Medical Center's CEO and for an independent evaluation of physician pay.

The meeting, held in Coulee Dam's town hall Monday night because of the anticipated size of the crowd, offered a nearly steady stream of news about internal hospital business and public disaffection of it. About 90 people attended.

It started with a discussion of $180,000 in bonuses paid after a year of employee sacrifice and cutbacks, then heaped on criticism of the current administration, including:

• a commissioner's tale of bungled billings on his own CMC account,

• a recognition of two health care providers who have cut back or stopped practicing in Grand Coulee due to the "current environment,"

• a revelation by one of them that she and four colleagues, following a vote of no confidence in administration last year, are now under investigation by a state regulatory agency.

Commission President Jerry Kennedy asked Chief Executive Officer Scott Graham to report on the awarding of a set of bonuses to administrators and health care providers in January, of which Kennedy said the board only recently learned.

Graham said $180,000 had been budgeted for bonuses tied to performance goals. Kennedy said that roughly $150,000 had been paid to administrators and $30,000 to health care providers in January.

Graham said the money was tied to meeting goals such as meeting "HUD covenants" (making the mortgage payments on the federal Housing and Urban Development-backed financing of the new hospital), meeting the requirements of regulatory agencies, and assuring increased patient satisfaction.

"We hit most of the targets," he said.

But audience members asked why bonuses were given after a year of asking staff members to sacrifice through "low census" staffing protocols that require employees to stay home and draw vacation pay, if available, at times when not enough beds are full.

"Are those minimum income kinds of jobs that you're sending these people home on while you get a bonus for actually doing the work that you're supposed to be doing for your great salary?" asked Alan Cain. "This is corporate nonsense."

Graham said all employees, including those in leadership, were subject to the low-census forced vacation time. But the goal is to hold that necessity to a minimum and to include bonuses for all workers in future planning.

Graham said $100,000 has been budgeted for 2014 bonuses, a practice he said helps incentivize high performance teams.

He said he has been attending staff "huddles" and has reinstated a "CEO walk-around" the hospital, and he has been "reaching out" to try to improve communications with providers and will schedule all-staff meetings.

Graham also reported that due to changes in federal regulations under the Affordable Care Act, CMC would be able to offer discounted lab testing services like those discontinued last May, but they would be offered year round.

In a public comments period, Courtney Eagle challenged Graham's effectiveness in his late outreaching to staff. "If it's so awesome there and you're doing so much to make sure your staff is happy, then why am I losing my provider?"

Her reference to nurse practitioner and midwife Dawn Lovelace's resignation two weeks ago, struck a chord with the crowd, who gave Lovelace and Advanced Registered Nurse Practitioner Wendy Hughes standing ovations.

Clea Pryor, who said she has worked for the hospital off and on for 30 years, charged that it is now understaffed to the point people have to wait for hours to be seen. She knows several staff of more than 10 years who have recently left.

"We have worked as a community for 20 years to get our hospital to the point it is," she said, "and the administration has single handedly destroyed it in less than three years."

Chief of Staff Dr. Andrew Castrodale recognized Lovelace's contributions to the hospital through her 20-year career.

"You're losing a very, very valuable provider," he said, underscoring that she left because of "the current environment."

He said Wendy Hughes will no longer be practicing in Grand Coulee, but seeing patients in Coulee City and working one day a week in the emergency room at CMC.

Hughes said she had to follow the advice she gives her patients - to put her priorities in order. She named the "stressors" that preceded her stepping back from her daily practice at CMC.

Hughes said she and four other colleagues are being investigated by the Nursing Quality Assurance Commission for "inappropriate practice," an investigation that started after the medical staff took a vote of no confidence in Graham last fall.

Commissioner Geary Oliver moved to authorize CMC's lawyer to hire an independent man experienced in hospital administration to investigate whether there are grounds to terminate Graham's employment "for cause." That motion passed 3-1, with Commissioner Greg Behrens voting against it.

Commissioner Kris Hare moved to hire independent firm ECG Management Consultants to do a fair market review of physician salaries "in order to resolve disputes with Drs. Castrodale and Chaffee." The motion was unanimously approved.

Attorney Randal Stamper was charged with carrying out both initiatives.