Friday, January 04, 2008


Residents of Del Rio and Val Verde County in Texas have had it with the non-profit, yet truly corporate management of their local hospital.

For years they were happy with services they were being provided and then along came Community Hospital Corporation (CHC) and everything went to, pardon my use of the word, shit. Patient services declined, employee morale went in the tank, a board which was set up to give locals control seemed ineffective or unconcerned, and the hospital CEO was given near dictatorial powers.

Over the concerns of CHC the Community Hospital Board did hire Dr. Susan Korbel to conduct a research project last fall about the performance of the hospital. In her executive summary report, Korbel described an atmosphere of mistrust between staff members and hospital administrators, and between citizens and the hospital in general.

The report includes court-recording-style transcripts of all comments at two public forums held at Ramada Del Rio Ballroom, Nov. 1 (angry resident pictured here at one such forum). Korbel sub-contracted with Ximenes Associates, San Antonio, a public relations firm with experience in public involvement on controversial projects, to organize and analyze results from the forums.

What came back was an avalanche of angry comments from actual and potential patrons of the hospital. Overwhelmingly the residents of the area found everything about the hospital to have deteriorated badly since CHC showed up.

By the way it wasn't only patrons who were upset. The same report found staff deeply discontented with CHC. As described in a Del Rio Live article in December:

“Testimony revealed, whether true or perceived, the Community Hospital Corporation (CHC) as the hospital administrator, their corporate board [Val Verde Hospital Corporation], and the voter-elected hospital district board have allowed internal issues to seriously hamper their ability to manage the hospital in a manner that promotes collaboration in the work place and trust in the community,” Ximenes stated.

“Time and again, members of the community spoke about CHC’s disrespect toward staff, nurses, and physicians as well as the decline in working conditions. Nurses have been forced to take on twice the number of patients as a result of massive lay-offs or forced resignations. It seems in the past the hospital provided full-time security, employee meals, and regular work schedules requiring very little overtime. According to testimony, currently there is no daytime security on duty, employees are responsible for their own meals and the cafeteria is not open on the weekends, and many employees are working overtime on a regular basis. There is a lot of resentment that locals are losing their jobs to contract nurses, and that the entire organization is losing its local stake in its only hospital.

“Most speakers expressed the belief that CHC does not promote open lines of communication between the management and the employees, nurses, or physicians. Employees are fearful of speaking out against management. They have seen former employees try to improve working conditions only to be terminated without explanation. The administration seems to be taking a ‘hands-off’ approach to employee relations and placing emphasis on acquiring more equipment and building more parking. This approach has resulted in decreased morale and a loss of qualified and respected local physicians, nurses, and staff. Which in turn has resulted in a decrease in the standard of care and a lack of consumer confidence,” Ximenes reported.

Like everyone else physicians laid much of the blame for the hospital’s problems at the feet of Plano-based Community Hospital Corporation which manages operations there.

Now, if you are like me, you have come to be suspect of the notion of "non profit." I've worked in lots of non profits myself. Some were okay and some were little different than for profits paying huge salaries to CEOs, cracking down on employees, and cutting costs and services wherever possible (yet receiving the benefits of being treated like some little community organization struggling to get by).

It's a scam.

And then there are those community boards and advisory committees that often are either so cowed by the big boys or so enamored with their own titles that they forget what they are supposed to be about.

This is not to say that some community boards actually want to represent the community only to discover they have no power. For example the CEO of the hospital we've been discussing has veto power over any decisions of the community board. Finally, at least some board members in Del Rio feel they have lost power – or never had it to begin with.

“I thought I was a representative of y’all and I come to find out you have representation without representation … I find that very disturbing,” said district board member Barbara Plyler, who struggled emotionally to speak in a voice higher than a whisper at a recent forum.

Meanwhile, you and I and the little dog next store get treated like customers at your local big box store...glad to have our money and just as glad to forget about the notion of customer service.

Did I mention that these giant non profits are tax exempt yet get the benefits of our tax dollars?

Too many non profits have become big businesses where all too often our valuable money and other resources are going to support the bloat rather than the so called mission.

It's time that something is done. Laws and regulations need to be changed. Big bad non profits are going to ruin it for the many fine non profits which really are what they say they are.

Think about it the next time you get a heart rending mailing asking for your money. Take the time to check out who is asking for your money and more importantly what they are doing with it.

Somehow, in situations, like that reported on below, communities have to regain control. Isn't that how its supposed to be?

The following story comes from Del Rio Live!(Texas).

Val Verde Regional Medical Center: What citizens are saying

“Burn it down and start over!” exhorted a survey respondent, already personally inflamed. Concerned, sometimes angry citizens of Del Rio and Val Verde County showed pent-up frustrations in the feedback opportunity presented by Dr. Susan Korbel’s research project, commissioned in October 2007 by the Val Verde County Hospital District Board.

Board members voted to hire Korbel, owner/researcher, Core Research, San Antonio, to ascertain observations and beliefs of residents, physicians and Val Verde Regional Medical Center (VVRMC) employees. Wednesday (Dec. 12, 2007), Korbel delivered her summary of findings at an open, thinly-attended public meeting.

The full, published, 223-page report is only now coming to public attention, delayed by internal decisions to require Texas Open Records Act requests for the document funded with taxpayer dollars. LIVE! explored the comments of hospital staff members and physicians in an earlier report, What employees are saying, Dec. 31, 2007.

In her executive summary report, Korbel described an atmosphere of mistrust between staff members and hospital administrators, and between citizens and the hospital in general. Many citizens responded to Korbel’s online or written questionnaire invitations with constructive, albeit aggressive measures to repair problems of patient care and workplace appeal. Others were less demure.

A thoughtful respondent urged, “Ask CHC [Community Hospital Corporation, contractor managing hospital operations] to turn in its keys, disband the corporate board [Val Verde Hospital Corporation], asking some members to lend their business expertise to the district board so a new contractor with proven credentials can be found ASAP.”

Though VVRMC is registered as a non-profit corporation, and, thus, cannot turn away any patient based on inability to pay for services, many respondents expressed suspicions that CHC is very profit-oriented, even to the denigration of proper patient care. “Contracts are to bring a profit for the company. Stop contracting, and take over our hospital,” demanded one commenter, continuing, “I remember the good old days, and I am only 48. I had two kids, appendix surgery, gallbladder, dislocated shoulder – so I have experience. I have seen the decline.”

Though the elected Hospital District Board contracted the Korbel survey, there is also a corporate board, Val Verde Hospital Corporation, set up by Community Hospital Corporation about eight years ago when that organization won the contract to manage VVRMC. The corporate board has one seat reserved for the chief executive officer of CHC (currently CEO/President Mike Williams) who has veto power over any board decision. None of the corporate board members attended any of the forums or presentations by Korbel, and they voted to refuse the district board’s overture to participate in funding the study to learn what people think about VVRMC.

Many respondents showed frustration that their elected representatives claim to have so little say over how to correct management and patient care issues, despite the fact that the Hospital District Board holds the contract with CHC. “Dissolve the contract with Community Health Care [sic, Community Hospital Corporation],” demanded one respondent. “Fire the company that is running the Hospital and let our local board run it,” said another.

One citizen offered an 11-step plan for remediation. The first three steps were, “(1) Terminate the current lease with CHC, (2) Enter into a new operating, management, or consulting contract with a reputable Health provider, insuring that the contract provides that the elected hospital board retains responsibility for and control of the district’s operation and equipment, (3) Ask for the resignation of current Hospital Board President [Bob Boland].”

Korbel cited many responses that demonstrate a continuing erosion of faith in good service and patient care at VVRMC: “Why is the hospital serving fewer patients? The population is not declining, nor have the residents become so healthy that they no longer need hospital care. Mr. Houghton [VVRMC CEO Jack Houghton] has stated that 32% of the potential patients are presently going to San Antonio for medical services. Some residents say that they are taking their relatives across to Mexico for many services, including emergencies. More than one survey response showed a lack of trust in the facility,” Korbel said. She cited one comment as an example: “Believe me when I say it’s common knowledge around town to go to the VVRMC only if you have no other option.”

Korbel described commenters’ feelings about the contract with CHC as “Similar to the ‘elephant in the room,’ – the contract renewal has become an issue that permeates most discussions. On November first, during a conference call with Jack Houghton and Mike Williams, Mr. Williams initiated a discussion about the contract, stating that ‘There are fiscal implications of the termination of the lease’ which require six months notice in July 2009 before the expiration in January 2010.”

Speakers at two public forums held in Ramada Del Rio Ballroom, Nov. 1, had much to say about hospital administrators and what they see as the Val Verde Hospital District Board dragging its feet in dealing effectively with the contract with CHC. Gisela Lenz, signing in as “citizen,” told District Board members present – Bob Boland, John Plumb and Barbara Plyler – “Since our hospital has gone with CHC, a private non-profit management company, things have gotten bad. Doctors, nurses and other hospital employees are not happy with the current corporation … For some reason, hospital employees are not appreciated and our great doctors are treated with the utmost disrespect … We need our county hospital. And if need be, we the taxpayers and the doctors will run it again.”

Shirl Marshall offered observations on employee – specifically nurse – morale. “For some reason we have started treating them like trash,” he said. “We have started treating our nursing staff like they were throwaway children. We give them no respect. We fire them out of hand. We make life so hard on them that they cannot stay there any longer … I go over to the hospital now and I look around and all I see are traveling nurses. It’s not right. I’ve talked a lot – I even talked to some of the traveling nurses. I talked to one of them right out here, at Wal-Mart. She was actually crying. She said, ‘I can’t stand working at that place.’ I asked her what the problem was, and she said, ‘Too much administration, too much administration.’”

Dan Riley, activist interested in hospital issues, commented, “…one of my biggest concerns is the citizens of Val Verde County and employees of this hospital have lost representation through our district board … It [VVRMC] is being operated outside the authority and control of our elected district board members with CHC corporate board exercising controlling authority.” Riley declared, “I feel that [the] hospital board should share some of the accountability along with CHC because there are avenues that our board could have taken to restore authority to this entity.”

One speaker, Darrell Breckenridge, spoke warmly – making no comment on hospital administration – about good service from hospital staff members in the obstetrics/gynecology and day surgery departments. “We have had four grandchildren born at Val Verde Regional. Mothers and babies were professionally cared for … Of a special note and my primary reason for coming today is to praise the day surgery department. I have had several procedures and all have been very comfortable, uneventful and even pleasant,” Breckenridge said.

Linda Ximenes, owner/manager of Ximenes Associates, San Antonio, was subcontracted by Korbel to record and summarize citizen comments offered by the 21 speakers at the forums. Ximenes minced no words in digesting the tone of the two sessions: “Members of the community spoke about the hospital district board’s decision to ‘relinquish’ their power to the CHC corporate board. They expressed feelings of betrayal and misrepresentation.

“The hospital board members were urged to ‘take back their board’ and regain local control. More than once, the voter-elected board was threatened with being ousted if they were not willing to ‘step-up’ to CHC and ‘fix the problem’ … The locally elected board is the voice of the Del Rio community, and they are being held accountable for their decisions that have resulted in a disproportionate power structure that gives CHC ultimate control.”

Ximenes also summarized a potpourri of comments manifest in testimony with enough frequency to be seen as trends by the researchers. Examples include:

“With regard to the corporate structure CHC has established, many community members expressed dissatisfaction with the CHC’s chief executive officer’s [CEO/President Mike Williams, CHC, Plano, Texas] ability to overturn decisions made by the locally appointed corporate board [Val Verde Hospital Corporation]. Some view this as a form of dictatorship that goes against the principal of a publicly owned facility supported by taxpayer dollars.

“Many believe there is a conflict of interest created with legal counsel [Quinton Etzel] representing the hospital [District Board] and the corporation [for unpaid bill collection].

“Furthermore, speakers believe the hospital chief executive officer’s [Jack Houghton] 18-month tenure should have produced some kind of improvement. However, the community seems to equate his tenure with increased mismanagement, displaced authority, and a loss of compassion for the people of Del Rio,” Ximenes wrote.

“In conclusion, the public has been losing trust in the management and administration being provided by the Community Hospital Corporation over many years … The community would like to see local control reestablished, the contract renegotiated or terminated, and most importantly, the standard of care restored.”

No comments: