The headline from the August 17th Mendocino Coast District Hospital's special Board of Director's meeting: The MCDH Board voted to grant Dr. Diane Harris a ninety day extension to negotiate a new contract for her continued physician services at North Coast Family Health Center (NCFHC), the hospital affiliated clinic in Fort Bragg.
The agreement did not come about until enough “failure to communicate” kerfuffles to land Cool Hand Luke a months worth of “night in the box” punishments (To anyone beyond the age of twelve who fails to understand a Cool Hand Luke reference may I suggest an immediate viewing of the 1967 film classic – culturally and educationally it is more important than tomorrow's homework).
A months worth of kerfuffles is precisely what's been going on at Mendocino Coast Hospital, at least at the administrative level. There are some fine people laboring in the trenches at MCDH, from doctors and nurses on down the pay scale. Unfortunately, for at least a half decade if not longer, the Chief Executive Officers (CEOs) at MCDH have not been keeping close tabs on their physicians contracts and the Boards of Directors have not been following through in keeping close tabs on their CEOS. This leads to all sorts of problems, not the least of which are billing oversights and exposure to Stark Law violations (See my June 3rd article for an explanation of Stark Law – Thankfully not all knowledge is gained through the cinema; you don't have to watch the Tony Stark character in Iron Man to grasp the fundamentals of the Stark Law.). MCDH is still in the process of paying off about $200,000 in federal Stark violation penalties, another $200,000 or so having already been paid while MCDH was coming out of bankruptcy.
Into this climate of uncertain physician contracts marched one Bob Edwards, the newly hired hospital CEO at a salary of $320,000 annually plus benefits. Keep in mind that the city manager for the entire municipality of Fort Bragg, CA makes only slightly more than half of what MCDH is paying Edwards. At some point after he was hired this spring (exactly when is a nebulous truth to get at) Edwards discovered that four of North Coast Family Health Center's long time doctors' contracts were about to run out. On what was obviously very short notice the four physicians were asked to re-up. Dr. Jason Kirkman did so. Apparently, Drs. John Cottle and Jennifer Kreger had reservations about the contracts proffered to them by Edwards. They both asked for two month extensions to their existing contracts to consider the new contract and continue negotiations about said same contract. In a hastily called, special Board of Directors meeting in July, (Dr. Bill Rohr, MCDH Board member, described being told at 1:30 or 2 pm that a meeting was occurring later that afternoon) the MCDH Board of Directors approved the negotiation extensions for Drs. Kreger and Cottle. Left out in the cold was Dr. Diane Harris, the fourth North Coast Family Health physician with an expiring contract. Harris claimed that Edwards had told her four days before her old contract expired that she needed to 'suck it up' and sign the new contract. A contract a pair of her colleagues had already questioned enough to ask for two months of extended negotiations.
In a public statement concerning the contract problem, Harris stated, “Two days before the end of the contract with three doctors unwilling to sign the new contract... I requested to see the latest version of the contract and Ilona Horton (NCFHC administrator) refused to give it to me saying that she and Bob Edwards decided to let my contract expire, and that they weren't going to negotiate with me any more. The next day I found out that the MCDH Board met in emergency session and gave the two other doctors who also wouldn't sign the contract a 60 day extension on their contract for further negotiations. I asked the Chair of the Board [Sean Hogan] to schedule a special meeting to extend my contract in the same manner. My request was declined.
“The administration didn't consider the effects of their actions on my patients, myself and my family, and on the community. Patients have had multiple reactions to the news of disruption of continuity of THEIR care. They like me and are very supportive of me. But they are flummoxed, furious and frustrated, deeply distressed and disoriented. They have said the following: The lack of consideration for the patients is immoral. What is glaringly absent is a focus or concern for the sacrosanct relationship between doctor and patient, and the healing process. I have found Dr. Harris to be knowledgeable, agreeable, and helpful. Clearly she is smart and patient-centric. I have valued my sessions with her and feel she is one of the best doctors in the area. It is incomprehensible that the administration would allow this to happen.”
At the August 17th special board meeting an assortment of Dr. Harris' patients filled the board room, many rose to praise Dr. Harris's manner and method of medical practice and to express their displeasure at the abrupt nature of her termination as well as dismay about lies told to them concerning Dr. Harris' absence by North Coast Family Health officials. MCDH Board Chair Sean Hogan said there was nothing to be done at this particular meeting because Dr. Harris' matter was not on the agenda.
Indeed it was not, but newly elected (last fall) Board member, Dr. Peter Glusker spoke up to make an emergency motion that the matter be discussed. After what appeared to be defensive maneuvers by John J. Ruprecht, the MCDH Board's local attorney, Dr. Bill Rohr seconded Glusker's motion. Hogan and fellow Board member Kitty Bruning (along with Glusker and Rohr, newly elected in November, 2014) voted 4-0 to continue discussing the Harris matter (fifth Board member Tom Birdsell was absent).
Almost as soon as discussion ensued, Dr. Glusker motioned that Dr. Harris be granted a similar extension period to that offered to Drs. Kreger and Cottle. Again Ruprecht proved reticent to move forward with anything so novel. He halted discussion several times under the pretext that he was trying to protect the hospital from potential litigation and further Stark Law violations, but from this vantage point it appeared that Ruprecht was doing all he could to stop Glusker's motion and block the extension of Harris' contract.
While this was ongoing one couldn't help notice interim Chief Financial Officer Steve Miller leaving the room. Miller, who has been on duty during the period that MCDH extricated itself from bankruptcy, is about to finish his term of office and return to his home in Texas. He didn't need to do anything extraordinary, but he did nonetheless. While out of the board room, Miller called an attorney at Ober Kaler, the national legal firm representing MCDH. When Miller returned to the meeting he reassured the Board that MCDH could extend Dr. Harris' previous contract for as much as six months without any fear of Stark Law violations.
Miller's quick maneuver not only paved the way for Glusker's motion to go forward, but undermined attorney Ruprecht's repeated delay tactics. One might say it also demonstrated his lack of legal knowledge on the same topic he made a point of bringing up.
Roll call on Glusker's motion went forward, with an amendment that she be given a ninety day extension dating from August 1st to make up for the time lost in potential negotiations. Glusker and Rohr voted to approve the negotition extension for Dr. Harris. After a moment's hesitation, Kitty Bruning abstained. Board Chair Sean Hogan, a retired attorney, at first abstained also, then changed his mind and announced that he was recusing himself from the vote. The recusal came with little discernible explanation. So, by a 2-0 vote Dr. Harris was granted a contract negotiation extension similar to Drs. Kreger and Cottle.
A closing note: at the August 17th meeting, new CEO Bob Edwards denied telling Harris to “suck it up” and sign the new contract. Immediately thereafter several members of the public could be heard voicing their disbelief in Edwards' words.