The City Commission of Arkansas City and the South Central Kansas Medical Center Board of Trustees held their first steering committee meeting May 10 at City Hall.
Relations between the two boards have been strained in the last few weeks, partially due to continued conversations about SCKMC’s flagging finances.
The meeting was called without any clear indication as to what the goals of the steering committee would or should be.
Warren “Hap” McLeod, newly appointed chairman of the SCKMC board of trustees, made the initial push for the creation of the committee.
“The original resolution started with you, Hap (McLeod), to do this steering committee?” asked Mayor Dan Jurkovich. “What was your intent?”
“Well, everybody says the communications between the commission and the board have not been that good. I pretty much agree with that,” McLeod said.
“We’re making an attempt to improve that. … There are some issues that have to be discussed, like non-elected personnel, and so we invited you … guys to our executive committee meetings, so that we can talk about some things that we’re not allowed to talk about in public.
“But I’m glad to meet in a public meeting, as well. I think there’s a lot we can improve on there.”
“So you think the communication is poor because there’s just things that the board doesn’t want to say in public?” Jurkovich asked.
“Can’t (say in public),” clarified SCKMC Chief Executive Officer Virgil Watson.
“Some of it is we can’t,” McLeod added. “I think the presentations could be better. There are a lot of very complicated issues at the hospital. It’s very difficult to discuss those in a one-hour meeting. What really needs to happen, if we’re going to make a presentation to the commission, is to hone in on certain issues that can be discussed publicly and go over those (with) the commission. What happens is we make very detailed financial reports … and it really can’t be thoroughly covered in just a few minutes.”
Detailed reports and difficult discussions
McLeod said he would prefer that SCKMC’s reports to the full City Commission occur on a quarterly basis, instead of the current monthly ones.
“You guys basically hired us,” he said. “I came from the corporate world. You guys are basically upper management to me, and I used to do upper management reports. You can’t make a report in detail like we’re getting and understand the big issues. I think we’re getting lost in the weeds and not focusing on the big issues in the reports that are made. There really are things we can’t talk about.”
“Like what?” Jurkovich asked.
“The big issue is we’re losing money. … If we were making money, we wouldn’t be here today. There would be no controversy. The biggest issue that we can’t discuss is contracts that are not working for the hospital’s profitability,” McLeod replied.
“That’s the number-one issue (at the hospital), contracts?” Jurkovich asked.
“There’s a few gorillas in the room. That one is probably the most complex, the most difficult, the most politically difficult, the most operationally difficult. It needs to be discussed — has to be discussed, as I understand it — in executive session,” McLeod said.
“Beyond that, we’re losing a lot of money in the emergency room. We’re discussing solutions for that. I think the commission needs to be more involved in some of these issues, for sure. … Those are the two biggest issues facing us right now.”
“If your budget is $35 (million) and you bill $35 (million), but you know you’re only going to get $14 million, you’ve got to figure out a way to live within $14 million,” said Commissioner Kanyon Gingher.
“The hospital, over the last couple of years, has implemented many programs designed for profitability. That has not shown up on the bottom line yet, frankly. That, to me, makes an execution problem, or we need to understand it better,” McLeod continued.
“But if there aren’t good explanations, I think we need to look a lot closer at execution as a broad topic. For example, we bought Winfield Medical Arts last year. Certainly, everyone is disappointed from the financial results of that purchase — and that’s an execution problem.”
“So the reason you’ve proposed this (steering committee) is so that the commission can understand the issues that you’re dealing with, more than just the financial report?” Jurkovich asked.
“Yes. There’s lots of difficult decisions to make to improve the finances. The bottom line is: It’s absolutely doable,” McLeod said.
Commission airs grievance
Jurkovich offered his own perspective on what the commissioners could gain from the steering committee.
“Here’s where I think communication breaks down: It seems to me like, as a city commission we have, at least in public, asked questions of things that were a little more difficult than the board seems to have asked. And when we have, we have been accused of being against the hospital,” he said.
“So we ask, ‘Will this really work?’ or ‘Where’s the money going?’ and the assumption is that we don’t like the hospital or we think the hospital is bad when we ask questions. That is my problem. Why are we seen as against the hospital when the questions seem pretty reasonable?
“We were told one thing, and it seems to never happen. We’re told something and then it’s something else. And then we’re told something and then it’s something else.”
“I would say, in my opinion, maybe it’s the way the questions are asked. Because we ask the same questions in our board meetings. We ask those questions. Maybe it’s the tone, maybe it’s the presentation, that it comes across like, ‘You guys didn’t even ask this, when we have asked,’” said former SCKMC board chair Carol Hearne, whose term expired in April, but has not yet had a replacement appointed by the city.
“I didn’t see it when I was at the board meetings,” said Jurkovich, who served as the commission liaison to the board of trustees for two years before being replaced by Gingher in January.
“Winfield Medical Arts, when that was (voted on), I don’t remember any questions asked. It may have been covered in executive committee. But by the time I went to a board meeting where it was going to be approved, Dr. Winblad was there and it was really more of a ceremony of congratulations.”
“The question, I still wonder, is the contracts with these doctors, did they have a minimum (amount guaranteed), or is there a certain amount of years that the doctors have to serve?” Jurkovich asked.
“I think conceptually it’s a great move, but the execution has been terrible,” McLeod said. “The contracts have incentives in them to do well.”
Executive committee secrecy
The mayor continued to stand by his statements about the lack of board discussion in public regarding the purchase of WMA.
“Nowhere in (a) public meeting were there discussions,” Jurkovich said. “I think it’s more than just a communications problem.”
“All I know is the Winfield Medical Arts purchase, (hospital attorney) Otis (Morrow) and the Wichita lawyers worked on that contract for months. It was always mentioned during a meeting, where are we on these contracts?” said SCKMC Board of Trustees treasurer JoLynn Foster.
“The executive meeting, because I didn’t ever hear anything about that,” Jurkovich stated.
“Our executive committee meetings,” Hearne confirmed. The executive committee has four members and its meets are not open to the public.
“I found out since the meeting, some of the doctors have come and talked to me, that it would be almost impossible for a clinic to be profitable right away. When you get a new affiliation, everyone has to be re-credited and it probably will take six months,” Jurkovich said.
“Now, maybe the doctors were not being accurate. But probably there wouldn’t be any angst if people knew it would be six months (to profitability). Those questions have got to come out and it’s got to be said before you lose the money.”
“But I think at the board (level), we understood,” Hearne said. “We just started getting the increased reimbursement.”
“But not before the purchase,” Jurkovich said. “I was in those meetings. Winfield Medical Arts was never mentioned until it was purchased. And the only way I knew (about the plan) was that I was told behind the scenes.”
“And I would say you’re correct, that that part was not mentioned until after we bought it. That was mentioned in executive session in (a) full board (meeting). But after that point, we were talking in (the) regular meeting,” Hearne said.
“I think they over-promised us,” McLeod said, adding that the hospital administration provides estimated cost savings or revenue increases from new programs, but that the actual numbers don’t always match the estimates.
“Sometimes, it takes a while for those numbers to come through. You may not see the annual results for one or two years,” McLeod said.
No urgent care?
A conversation about SCKMC’s plan to start urgent care in its emergency department in June took an unexpected turn when Gingher revealed certain facts she had uncovered.
“We’re looking at converting part of the emergency room into an urgent care (clinic),” McLeod started the discussion.
“I’d love to have the commission more involved in making that decision.”
“Most recently, we were told at the City Commission meeting, and we were told at the hospital board meeting, that we would have a 24-7 urgent care that you could come in and be triaged, and go this way to urgent care and this way to the ER,” Gingher said.
“We have told our public, (the) city manager has notified employees and potential businesses that are coming to town, that we are going to have this incredible opportunity to have this urgent care. When I started to discover that was not the case, I tried to reach out to some people, ‘I’m trying to get ahead of this. I’m letting you know. I don’t want you to be embarrassed. I don’t want you to have improper answers.’ I was told, ‘That’s not correct,’ ‘There’s no way,’ ‘Not going to happen.’ When I talked to the doctor who is in charge of the ER, he said, ‘Um, no. I don’t know anything about it. I’m not part of it.’ And I said, ‘How’s that possible? It’s your program.’ He said, ‘No, it’s not. My program is StatCare.’”
StatCare is a program in which emergency department employees can try to make the department more efficient, according to Gingher.
“It does not mean cost savings (to the patient). It does not mean any benefit, other than getting into the ER faster. They have no urgent care. In fact, he said to me, ‘Why would I?’ I’ve never seen him at a board meeting to explain the program. Early on, I asked, ‘Can you have an urgent care out of the ER?’ I was told ‘Yes.’ Well, I’ve checked … you can’t. When I reach out to you (board members) at different times to talk about it, … (I’m told) ‘We got it.’ When I say I’ve made these phone calls, I hear, ‘Well, we need somebody professional to make these calls,’” she said.
“I’ve never been big on ‘sit down and don’t worry about it. I want to know the answers. … My bottom line is to protect the citizens, the employees, the people who depend on that hospital for one reason or another. I want to see it succeed. The citizens don’t care — they want a want a workable, usable hospital that they can afford.
“Urgent care was supposed to start June 1. It’s not going to start June 1. Not unless you throw something quickly together and have problems with it.”
Gingher also defended the public’s right to know what is going on at South Central Kansas Medical Center.
“When a commissioner or a member of the public says, ‘Look, there was no talk whatsoever, they just walked in, sat down and did it in under two minutes,’ (it is a problem). They can’t see what’s going on in your executive sessions… That’s why they struggle every time to get the facts out there to the public. That’s why Dan (Jurkovich) didn’t want to have this meeting in private. We were supposed to have three commissioners and three board members. I don’t mind,” she said.
There were five SCKMC board members present at the meeting, two more than the steering committee was intended to have.
Purchases and contracts
Gingher highlighted other issues she had observed with the board.
“Purchases are made and not always cleared, whether you have the financials to pay for them (or not),” she said.
“I’m not here to condemn any of you guys. JoLynn (Foster), I think you’re brilliant. You said you didn’t think we thought you were smart enough. But you’re not willing to go to battle with me. … Going to battle means fighting for the citizens, fighting for this hospital. So when we want to know what’s going on, when we ask a question … if you think your staff is being beat up on, then show up, and stand up.”
“I’ve asked several times if (the hospital) attorney is reviewing the contracts. I’ve been told that there was a contract, though he does not at all object to it, (that) he never saw. Every contract should go through your attorney,” Gingher added.
“Who told you that? Who said that there was a contract that Otis (Morrow) didn’t see?” asked board secretary Karen Zeller.
“Otis,” Gingher replied. “Is that correct, Otis?” Zeller asked Morrow.
“I don’t know what she’s talking about, she’s going to have to…” he answered.
“Carmine DiPalo’s contract,” Gingher said, referring to a hospital consultant.
“Oh, yeah, that’s true,” Morrow said.
“I’m not going to come to you and fabricate information,” Gingher said.
“Well, I just wonder where you’re getting your information,” Zeller said. “From everybody,” Gingher replied.
The group the discussed procedures for contracts for some time, without defining a clear-cut process for either contracts or purchasing.
Ultimately, the steering committee outlined several key topics to begin trying to provide direction for the hospital going forward.
Among those were contract negotiations and improving communications.
The steering committee will meet again in two weeks at the regularly scheduled SCKMC Board of Trustees meeting at 7:30 a.m. May 24.