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Wednesday, 05 March 2008 00:00

Forgive yes, but first a look at HRMC’s recent past

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The healing power of forgiveness is at the top of the list of things in which I believe strongly. It’s the best drug on earth, doing more good for more people than anything a doctor ever learned in medical school.

Before we start handing out any pardons in the unfolding saga of Haywood Regional Medical Center, however, doesn’t it make sense to first confront a more fundamental part of the healing process — the admission of guilt? Who did wrong, how culpable are they, and how did each of them — and everyone else who pays attention — let this happen?

I know there is a huge wave building to just join hands, sing “Koombaya” around the ashes of David Rice’s resignation, and pray that a contract company from Cincinnati can lead HRMC and the Haywood community to the promised land where local hospitals thrive and nearly 1,000 jobs are kept intact, but it just ain’t that simple.

•••

When it was announced that HRMC had lost the right to collect Medicaid and Medicaid funding, and then that Blue Cross and Blue Shield had dropped it from its network, many felt sure the 170-bed hospital was falling face first into its grave. And that may be true yet, but an amazing thing happened on the way to the funeral: the community has rallied around its hospital. On Monday of this week there was an outpouring of support so strong it was palpable at meetings held throughout the community. Now, many are encouraging the media and others to just leave well enough alone, to concentrate on survival rather than blame.

But let’s play devil’s advocate. How many think HRMC would have been better off — would have better fulfilled its role as a community healthcare facility — if this crisis had never occurred? I’m sure many people would answer yes to this question. All would have been OK, according to this line of thinking, to have let this hospital stumble along under a CEO everyone is now so quick to criticize.

But there’s a whole lot of people — doctors who have been run off by the administration, nurses and therapists who have quit because of a workplace that was about intimidation and fear, faithful employees who have been too scared to speak up, and patients who might have suffered from some of those mistakes — who would probably argue that even though the current situation is deplorable, it was inevitable. Ten days ago, it was a hospital that showed a smiling face to the community while hiding multiple problems beneath the veneer.

So who gets to go to the altar, seek forgiveness, and confess to a few mistakes alongside David Rice?

•••

The first realization that everyone who knows Rice can attest to is that he is not incompetent. He is a smart man, and so he was able to convince others that his mistakes were good decisions. He was just wrong about a lot of things. I am confident that he believed he was acting in the best interest of the hospital all the way to the end.

His top administrative staff has to feel pretty lucky. As part of Rice’s team, they toed the party line, whether by choice or out of fear. If they were speaking up about anything, they simply didn’t have the force of personality to budge Rice. As a group they were in a tough situation, no doubt, but it would behoove them to offer the community and employees apologies. As lower-level administrators, they get the opportunity to learn from this episode rather than burn. The one lesson they should embrace is to adhere to one of the mantras now being tossed around rather loosely these days — transparency.

Administrators are saying they will be more open than ever with information, but the truth is that the media is already having real information parceled out in teaspoons while being flooded with the feel-good propaganda. Perhaps some don’t know the difference, but it’s now time to learn.

•••

The hospital board is still in the firing line. There has been at least one public call in the past week for Dr. Nancy Freeman, chairman of the board, to resign from her position. Others have said the entire board is to blame.

Freeman, for her part, did apologize to her fellow board members on Feb. 25, the night the Medicare fiasco went public and Rice resigned. It’s still not clear when she knew the severity of the potential problem and why she did not notify other board members and the hospital’s medical staff. As chairman that was her responsibility. One has to believe she was at least partially a victim of the administration’s tight-lipped culture, but there are times when one has to take a stand.

There’s also a responsibility to learn from past mistakes. Back when the hospital board was firing the ER group in December 2006, Freeman had this to say to a packed hospital board room upset at the decision: “It has been touted that the board was misinformed or misled. The board was not misinformed or misled on any issue. The board made this decision, not Mr. Rice. Mr. Rice works for us, not vice-versa.”

That’s a strong statement, one that she contradicted this week a couple of times when she said she was not given direction by administration and not provided all the facts.

This board has made mistakes, especially when it sided with Rice and refused to back up the medical staff’s recommendation for mediation during the termination of the ER doctors. It wasn’t leading, but was being led by the administration.

•••

The county medical staff raised objections to the hospital administration’s actions, again in December 2006, but it stopped short of passing a vote of no-confidence in Rice. As it turns out, they should have taken a stronger stand.

The firing of the ER docs foreshadowed a lot of the problems that erupted last week. Some doctors in the community continued to support the administration without fail during this contoversy, stroking administrative leaders who it now seems favored the bottom line over all else. Other physicians feared speaking out.

Four of the county’s most respected physicians did speak out at that December 2006 meeting, but it didn’t change the outcome. The board ignored the physicians, but the docs didn’t rise up as a unified entity to fight.

The medical community needs to sit back and look at what happened here — and what could still happen — and wonder if they should have done more.

•••

County commissioners in March of 2007 re-appointed Freeman, Dr. Richard Steele and Jim Stevens to the hospital board. This was despite the fact that at least two applicants who are respected members of the medical community pointed out administrative problems.

In fact, one applicant for a board seat was Dr. Henry Nathan, perhaps the most outspoken when it came to the administration’s actions. Nathan was one of four doctors appointed by the medical community to share their collective concerns with the hospital board over the ousting of the ER doctors.

“We rarely feel the need to interject our opinions on the board. When we do please take note. It is probably important. Please listen to us,” he said in December 2006.

Dr. Luis Munoz also applied for one of those board seats. Here’s what he said on his application: “In the last few years, however, there has been an alarming outflow of physicians and contractual disputes, resulting in tensions between medical staff and administration that are harmful to our community. I believe my established relationship with both the medical staff and administration can help this hospital, staff and the county move forward collectively and unified.”

County commissioners chose the status quo. In hindsight that was a huge mistake.

•••

And finally, we in the media need to take our licks.

For The Smoky Mountain News, I’ll admit to the sin of cowardice. Four years ago we started reporting on problems with orthopedists and anesthesiologists. When those doctors flew the HRMC coop, we reported on the issues with Haywood Emergency Physicians and followed up by reporting on problems nurses had with the way they were treated.

All along the way, we were reprimanded by the administration. When they pulled all their advertising, it came as no surprise. It hurt financially — at the time they were our largest advertiser — but we wrote it off as the cost of doing business. But when David Rice had his secretary call me to say we should pick up our newspaper boxes at the loading dock, that we were henceforth forbidden from distributing on hospital grounds, I began to see what we were dealing with. I went by David’s office that day to talk to him about this decision, and I sat outside for 20 minutes before I realized he wasn’t going to see me. Kill the messenger, intimidate the adversary, ignore the problems.

When few in the community seemed to take much interest in the stories, we began to doubt the value in doing them. My instincts told me we were right, but I relented. Our mistake.

As for the rest of the media, they danced around the story but never dove in. Until now.

•••

So it’s obvious the mistakes — not even counting the failed inspections — piled up over the last few years: loss of orthopedists, loss of anesthesiologists, loss of nurse managers, therapists and other staff, reappointment of board, ER docs, hiding letters about possible Medicare loss, last year’s cash flow problems, ignoring Dr. Aloha Bryson’s letters, and probably much more that none of us ever heard about. Now it seems obvious a pattern was developing.

This is a huge issue, and making light of it is not in anyone’s best interest. Lives, careers, and the economy of a county are at stake. But there are many of us who could have done more and done it earlier, but we were blinded to the red flags waving in our faces. Blaming this all on David Rice is a cop out. Those who love Haywood Regional Medical Center now have their work cut out for them.

OK, now I’m beginning to feel better and am looking forward to the healing. Nothing like a few mea culpas to refresh the soul.

(Scott McLeod can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. )

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