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1991-01-23 Regular MeetingC= KODIAK ISLAND HOSPITAL ADVISORYBOARD MEETING JANUARY 23, 1991 PRESENT: Gil Bane, Gordon Gould, Jon Hlavinka, Gretchen Saupe, Betty Springhill, Wayne Stevens, Jeannie Volker, Lorne White, Kate Fitzgerald, Director of Nursing, Norm Campeau, Interim Administrator. Also present was Anne Kalcic. ABSENT: Ben Ardinger The meeting was called to order at 7:00 P.M. ACCEPTANCE OF AGENDA: The Agenda was amended as follows: Blood Drive added to Old Business; System/Support Letters for C.O.N.; Addition of Physician to Board; and Board Liaison to Medical Staff added to Administrator's Report. Lorne White moved and Gretchen Saups seconded the motion to accept the amended agenda. Motion Carried. APPEARANCES AND COMMUNICATIONS Anne Kalcic, as patient advocate for Fern Fuller, shared some problems which she had encountered when trying to have Ms. Fuller admitted to the hospital and several other areas in which she had concerns. The four major areas which Ms. Kalcic felt that KIH/CC needed to address were: repairing the ER entrance, eliminating the bump; educating the staff in the proper chain of command for admissions when the department heads are not available; investigating and analyzing the incidence of accidents in the Care Center; and investigating the possibility of adding another wheelchair accessible entrance to the Care Center. Ms. Kalcic's concerns were noted and Mr. Campeau stated that they would be addressed by Administration. Gordon Gould moved and Wayne Stevens seconded the motion that the meeting minutes of January 9, 199 be adopted and approved. Motion Carried. Advisory Board Meeting January 23, 1991 Page Two OLD BUSINESS A. E.R. Coverage Update Mr. Campeau stated that a breakdown of hours for E.R. coverage had been distributed and explained the various hourly wages paid to the physicians. He stated that at the current cost and income levels of the Emergency Room, that department was projected to incur a loss of $299,280.00 for the coming year. Mr. Gould noted that the amount of accounts receivable written off by that department seemed inordinately large. Mr. Campeau explained that historically, emergency room bill- ings have the second largest non -pay percentage (30%). He indicated that KIH/CC had 4,300 emergency room patients last year, an average of 12 patients per day. He stated that if this volume of patients continue with the current level of coverage, the hospital will lose money. There was a brief discussion of adding additional staff emer- gency room physicians. It was noted that the emergency room billing structure was being revamped which will generate more revenue. It was the consensus of the Board that while it wanted emergency coverage to remain strong at the facility, that areas in which costs could be cut needed to be explored. Mr. Campeau stated that Administration would be developing a plan of action to change the fiscal direction of the facility. He cautioned, however, that the fiscal situation would not change overnight, noting that it was not created overnight. B. Van Update Mr. Campeau stated that the van for the Care Center was under con- struction and that delivery was estimated to be mid-March or later. Mr. Stevens asked how the cost of vehicle maintenance would be covered and who would drive the van. Mr. Campeau stated that employees of the facility would be properly trained and licensed to drive the vehicle and that he anticipated covering the maintenance costs by using the funds now being allocated to the Senior Citizen's Center for the use of their van. C. Blood Drive Mr. Campeau reported that because of state requirements for HIV test- ing, storage and other intricacies involved in the collection of blood, that KIH/CC could not at this time conduct a blood drive. Mr. Stevens asked how this facility provided blood to patients when need- ed. Ms. Fitzgerald explained that the facility keeps a certain amount of blood on hand and that as additional blood is needed, that it is obtained from the Anchorage donor bank. She noted that anyone wishing to get on the emergency donor list at KIH/CC could do so by contacting the lab director. Mr. Stevens asked if it would be feasible to invite the Red Cross to come to Kodiak to conduct a blood drive. Ms. Fitz- gerald stated that at this time, there was no shortage of blood in the state and that the Red Cross would not be interested in incurring the additional costs involved in such a drive. Advisory Board Meeting January 23, 1991 Page Three NEW BUSINESS A. Board Retreat Evaluation The general consensus of the group was that the retreat was worth- while, well planned and well facilitated. Ms. Springhill noted that she had received no negative feedback about the event. The summary of the retreat's events was distributed and discussion tabled until the next meeting. Noting that improved communications between medical staff and the board had been one goal identified at the Board Retreat, Mr. Campeau distributed for the Board's review a policy which stated that the Advisory Board would not make any final decision which directly affected the Medical Staff until they had been advised of the proposed action and been given opportunity for input. Mr. Gould stated that he felt there were only two instances in which the Board addressed issues directly affecting the Medical Staff: (1) Bylaws and (2) appointments to Medical Staff. Following discussion about the proposed policy, Wayne Stevens moved to table discussion about the proposed policy until further work had been done. Gretchen Saupe seconded the motion. Motion Carried. Gil Bane moved that in order to improve the communications between Medical Staff and the Board that minutes of Board meetings be sent to each member of the Medical Staff. Wayne Stevens seconded the motion. Motion Carried. EXECUTIVE SESSION 8:05 p.m. The meeting recessed to Executive Session to discuss personnel matters. 9:30 p.m. Executive Session recessed and a brief recess called. 9:35 p.m. Regular meeting reconvened. ADNEDUSTRATOR'S REPORT (Continued) Noting that Administration felt inadequate to respond to the issues raised under the Agenda item, "Board Comments", and that the responsibility for the creation of the agenda was the Chairperson's, Mr. Campeau read a proposed policy which would request that board members contact either the Chairperson or the Administrator prior to the Board meeting about issues they wished placed on the agenda. Following discussion, it was the consensus of the Board that it did not wish to adopt this policy. Advisory Board Meeting January 23, 1991 Page Four The public hearing for the Certificate of Need is scheduled for January 29, 1991 at 3:00 p.m. at the Assembly building. Mr. Stevens, Mr. Gould, Mr. White, and Ms. Springhill agreed to write letters of support for the new facility and to speak in favor of the facility at the hearing and, further, to contact two other organizations or persons to write letters of support and ask those organizations or persons to speak at the public hearing in support of the CON. Mr. Campeau distributed a written Administrator's Follow-up Report. Copy attached. AUDIENCE COMMENTS None. BOARD COMMENTS Ms. Springhill asked about the status of the solarium. Mr. Gould stated that the proposal had gone into the Assembly's budget process. Mr. Gould noted that a letter, signed by several members of the Medical Staff, had been received. He asked that this be included as part of the minutes. Mr. Gould asked that the inclusion of a Board member as a liaison between the Agenda Board and the Medical Staff be placed on the Agenda of the next regular Advisory Board meeting. Mr. White asked about the status of the Jones Bill. This bill is scheduled to be prefiled on February 4. Ms. Saupe noted that the Quality Review Committee was scheduled to meet on February 1. Mr. Campeau asked that the Board advise him of their wishes regarding the recruitment contract for a surgeon. He stated that he felt the options were: (1) put the recruitment process on hold; (2) continue recruitment for a general surgeon; or (3) redirect the recruitment to include special- ties not available from the current surgeon. There was extensive discus- sion regarding this issue. Rayne Stevens moved to recommend that Administration redirect the surgeon recruitment process of Jackson i Coker to recruit another surgeon aug- menting the skills of the current general surgeon by utilizing the recom- mendations of the Medical Staff; that measurable performance criteria be established for the current general surgeon; and that the facility develop Advisory Board Meeting January 23, 1991 Page Five a contract with the current general surgeon which would include specified periods of off island rest and recreation, locum tenens coverage terms, and inclusion of a 90 -day contract termination provision. Noting that there were several different areas covered in the motion, Mr. Gould requested that the motion be split. Wayne Stevens moved to recommend that Administration redirect the surgeon recruitment process of Jackson 6 Coker to recruit another surgeon aug- menting the skills of the current general surgeon by utilizing the recom- mendations of the Medical Staff. Gordon Gould seconded the motion. Motion carried, seven ayes and one no. Wayne Stevens moved to recommend that the facility develop a contract with the current general surgeon which would include specified periods of off island rest and recreation, locum tenens coverage terms, inclusion of a 90 - day contract termination provision, and a means of establishing measurable performance criteria. Gordon Gould seconded the motion. Motion failed, five nos and three ayes. I:\ la C� 1: ►t►I 1 ►Y 1 Meeting adjourned at 11:30 p.m. Recorded by Debra Raper. Jeannie Volker, Secretary/Treasurer January 22, 1991 T0: Hospital Advisory Board This letter is drafted for Your consideration regarding the issue of recruitment of a surgeon for the island. We would like to address two points: 1. Approximately one year ago because of several instances where Dr. Alvarez left the island without providing replacement surgical coverage, the Executive Committee of the Medical Staff supported and encouraged the Hospital Advisory Board to pursue recruitment of a new surgeon. Since that time, the problem of temporary surgical coverage has been corrected by Dr. Alvarez, working with the administration. 2. The medical staff feels that Dr. Alvarez is a technically excellent surgeon. The above statements are supported by the undersigned. / --------- PROJECTED EMERGENCY ROOM INCOME STATEMENT YEAR ENDED DECEMBER 31, 1991 REVENUE: Emergency Room Revenue Less deuctions from revenue Net Emergency Revenue EXPENSES: Physicians Fees Staff Salaries Other Supplies Total direct operating expenses Net income (loss) before overhead expenses Overhead (47. of 5 million) anckEIIIiI4�, 6 222,000.00 ------------- $475,280.00 130, 000.00 12,000.00 ------------- Net projected income (loss) from operations $518,000.00 617, 280.00 ------------- ($99,280.00 200,000.00 ------------ ($299,280.00 KODIAK ISLAND HOSPITAL i CARE CENTER Subject: Advisory Board/ Date Written: 1/91 Medical Staff Communication Department: Advisory Board/Administration Date Revised: Distribution: Advisory Board, Medical Staff, Administration POLICY: The Advisory Board will not make any final decision that directly affect the Medical Staff of Kodiak Island Hospital i Care Center until the Medical Staff has been advised of the proposed action and been given opportunity for input. PROCEDURE: Any motion that directly affects the Medical Staff of Kodiak Island Hospital 6 Care Center will be tabled until the next regularly scheduled Advisory Board meeting. Each active member of the Medical Staff will be sent a copy of the proposed motion at least one week prior to the meeting when the motion will be considered. Chairperson, Advisory Board Administrator Date Reviewed wp5.1/macro/pol Initials Date Date KODIAK ISLAND HOSPITAL i CARE CENTER Subject: Advisory Board Meeting Agenda Date Written: 1/91 Department: Advisory Board/Administration Date Revised: Distribution: Advisory Board/Administration POLICY: The primary responsibility for creation of the Advisory Board Meeting Agenda rests with the Chairperson of the Advisory Board with assistance from the Administrator as requested. PROCEDURE: Persons.(Board members, Administration, Public, etc.) wishing to place items on the Advisory Board Meeting Agenda should contact the Chairperson of the Board. The Chairperson has also delegated this duty to the Administrator. The Chairperson and the Administrator will meet prior to each Board meeting and jointly develop the agenda based upon the requests received and operational requirements. Advisory Board Chairperson Date Administrator Date Reviewed wp5.1/macro/pol Initials Date ADMINISTRATOR REPORT TO ADVISORY BOARD JANUARY 23. 1991 I . We are currently considering major changes in the hospital security services in an effort to reduce the cost. Current direction is to eliminate the night security person with potential savings of approximately $88,000. 2. The C.A.T. building is scheduled to be placed on site January 23, 1991. Preparation work has been occurring this week. I will proceed to get the machine here ASAP. 3. Project 1D - Authority of Director of Nursing I have appointed the Director of Nursing as my replacement in my absence or.unavailability. 4. Project 4G - Fishermens Wives Donation We received $600 from the group for the purchase of a blood warmer. The purchase is in process. They also plan to donate $1,200 for a Crash Cart. 5. Project 2L - Temporary Human Resource Director This position was terminated effective January 4, 1991. 6. Project 2P - Central Treasury Function This process complete; all funds now deposited with the Borough. 7. Project 2K - Health Club Program A new form to assure employee responsibility has been developed and put into use. 8. Kodiak Island Mental Health Center The contract that required monthly payment of $1,200 to the local mental health center has been canceled as of January 1, 1991. Employees have coverage for these services through the employee health insurance program. 9. Project lI - Board Agenda A policy to define the responsibility for the Board Agenda submitted to the Board January 23, 1991. 10. Project iJ - Smoking Policy/Smoke Shack The smoke shack was closed to smoking on January 22, 1991. 11. The Director of Materials Management resigned effective January 15, 1991. We will not fill this position, resulting in a cost savings of approximately $50,600, plus benefits. 12. The Director of Nursing in the Care Center will now report directly to the Director of Nursing in the Hospital. Other changes will occur in the organizational chart after the situation has received more analysis.