Re-Gifted...(quotes)....1/5

Thought I'd decorate the tree, so to speak, with a few choice ones.

"We are attracted to Essent because its hospitals are financially sound(????) and provide essential, high quality(????) care to the residents of the communities they serve," said James L. Elrod Jr., managing director with Vestar's New York office."Essent's business model is consistent with our investing strategy. We are particularly excited about becoming partners with Hud Connery and his management team."

These are the folks that Hud and bud put on their little show for at the Med Staff meeting so long ago. They're also the ones that chipped in $80M for investment. That's why Hud made such a fuss about RRVR taking a fee from the hospital (false), and why he was adament on getting rid of them. Kind of a Hitleristic approach, might one say? One might. His version of the "big lie".

But, it served two purposes: Tarnish the reputation of RRVR, and allay the investor's fears...making them feel that profits would be up $1.2M (what they were supposedly paying the Radiologists to read films.)

So comes a lesson, of sorts. Just plugging in money to the wrong thing does not success guaranty:

“We’ve made significant investments in Crossroads over the past five years, including the construction of three medical office buildings, renovations to the emergency room, and a new 3,000 square-foot outpatient physical therapy facility,” said Bill Heburn, executive vice president, operations, Essent Healthcare. “Despite these significant investments, Crossroads posted a positive operating income only one year out of the five we’ve owned it."

After that, Bill's future was made...or un-made.

Rule Number 1: Never make Hud look bad or laugh at him or contradict him in front of someone. Heads will roll.

One also might wonder about Hal Andrews, and how he disapeared so fast: Apparently he and Hud had rehearsed some song and dance for the Essent board about something. Well, Hal inadvertantly said something that embarrassed Hud in front of the board, (according to HUD , himself) and the next thing Hal knew, he was fired. (Rule #1)

So, Rule Number 2 for PRMC execs: You serve at the pleasure of Hud. It could be that Drew's statement in support of Tony Williams will be imortalized here as well....frank

Glad Tidings?...8/10

Getting close, so I'll say Merry Christmas ahead of time. Guess we're going to find out who's naughty or nice....

From the Northeast--Naughty

Physicians at Nashoba Valley Medical Center strike again!!!! Another physician has entered into a Voluntary Agreement Not To Practice Medicine with the Commonwealth of Massachusetts, which was a disciplinary action. Dr. Rimas Maurukas, pulmonologist is the 5th in a growing line of doctors falling by the wayside in Ayer, Massachusetts. The doctors being investigated by the commonwealth are outnumbering the new recruits. Am I seeing a pattern here??? Quality care just seems to be something NVMC can't attain. Are double digits in our future???? Once again check mass med physician profiles (link on left list.)

From Texas--Naughty

Frank,

Radiology is the ugly-redheaded-stepchild of the hospital! Seems that we are being treated to re-runs of Laverne and Shirley: The courtship of Squiggy! Should someone dig a little into his previous work history, they might be surprised. But that does fit the average Essent recruit--dependent on Essent.

The first graduating x-ray class from PJC is taking their boards this month, and the proof is in the testing. With only a few lined up with jobs in a super-saturated market, it does seem like the students going into the field are a bit naive, and not making informed choices. It's going to be like those schools that are promoed on TV at three in the morning which had such pitiful placements. With 10 applications for each x-ray job, one might need to re-evaluate one's career choices.

From Texas--Nice

Hi Frank,

Someone is reading the blog because an email was sent out by Cheryl Perry to check your education and make sure all your tests are finished. (Referred to the insertion of educational requirements after the listed due date.)

So "Dash away, Dash away, Dash away all"!

Quis custodiet ipsos custodes???12/28

Just when you thought it was getting better:

I've been getting rumors, and now several folks have emailed that I probably should put the warning back on the site as to monitoring of PRMC computers. But, that isn't the only thing....

The clicking that you've been hearing on the phone lines--Yep, Big Brother. The new "smoke detectors"? Some have cameras built in to them. Might be interesting to see what ones actuate from actual smoke....
I've heard that the outlying clinics all have gotten their monitoring upgraded, as well as Aerofit (wonder where the cameras went there! Better keep the swim suits on in the hot tub!)...guess they feel when the cat's away....

Quis custodiet ipsos custodes? (Who watches the watchers?) Me.

Footnote: From a comment, looks like public opinion wins--apparently Huddie doesn't like the flak, and some of the cameras, if not all, have been replaced. Makes me all warm and fuzzy towards Essent. Now we just have to watch the various other appliances to see if they end up in those....frank

Okies from Muskogee....12/12

I'm sorry, I ran out on an ongoing story. MRMC did make a decision, and that was almost a month ago. They selected Capella, and follow the link to see what was agreed to. I really wish they had been the ones bargaining with Essent...for us.

The employees were taken care of:

"• Existing commitments to all employees won’t change."

And standard of care issues as well.

Well done, Muskogee! You get a gold star!

Just one more...well maybe...12/22

Hud Connery, President and CEO of Essent Healthcare commented, "Doctors Hospital is a perfect fit with the Essent model. Doctors Hospital is an essential hospital in the middle of a rapidly growing community. The hospital provides a fundamentally important service, there is a great team of physicians and nurses, and we hope to make the purchase of this hospital part of a grander scheme. It's just the kind of opportunity we were looking for."

For those who haven't followed the blog, Doctor's Hospital was renamed Crossroads--and is now part of SMS, not Essent, after Hud finally gave up. Cat-herding is rough business.

Okay, so just one more:

Quoted from the Paris Snooze, 7/25/04, "Knizley (PRMC CEO) said the best way to achieve such a prestigious rating (one of the top 100 hospitals) is by finding problems the best way he knows how -- by listening to employees."

We just never expected it to be through tapping phones, and bugging the smoke alarms....

Who's Who in Readership...12/12

Just thought I'd give you an update on who actually tries to find this site, rather than stumbling into it (from what I consider outside the norm):

• I've had hits from India, the Ukraine, Turkey, Israel, Italy, Austrailia, China, Iran, the UAR, and even one from Vietnam, but that was a fluke. And either someone has been sending links, or one individual has been bouncing off multiple international servers...because the MSN search is exactly the same for about five countries.
• Numerous mentions have been seen in Power Point presentations given in the Netherlands, Norway, and Germany....
• Various healthcare groups from all over the nation.
• Investment companies.
• Healthcare Management groups.
• Obviously, the highest percentage of hits are from Texas, Tennessee, Massachusetts, and Pennsylvania, but I was suprised at the high numbers for North Carolina, New Jersey (probably the new CEO for MVH and his family), Minnesota, Florida (not just Andrew's defender), and D.C.
• The Dallas hospitals love it, the Essent states camp on it after hours, and I don't know how many people have Google alerts for new comments.
• A chat room would probably lock up someone's server.

I don't get information on the user, just the ISP (Internet Service Provider), and Essent has their own fixed IP (handy for me), as do other various organizations.

Hard Questions...12/16

Last year, Merrimack Valley Hospital lost $87,205. They have been an Essent hospital for how long? Since 2001.

In retrospect, the first hospital (Crossroads) that Essent bought lost money for all but one year (out of five.) From the beginning, they put serious money into the hospital, but like the Titanic, it just kept going down.

Nashoba Valley made $537,676 last year, approximately the same percentage of return on their gross as PRMC. But, their Return On Investment (ROI) is far better, as the price was only $11M. They still have a little over a year to commit an additional $16M in improvements or a new structure. While ground-breaking for a physician's office building has occurred, we'll see how an actual replacement hospital shapes up in the next year. Kind of waiting until the last minute...maybe hoping for an exception to be granted? Or was the timeline on the new hospital completion left open--sort of like the lawsuit by the gay couple....

Sharon Hospital seems to be the cash cow of the organization: Approximately $3.7M from a gross of $98.5. And they got it at a price lower than that of NVMC ($16M outright and $8M more for improvements)! Guess it was worth waiting for--despite assuming liability for a toxic waste dumping problem in NY.

Paris had a total revenue of $363,370,383...yet only made $1.6M over costs. Maybe it's all those locums?

Southwest wasn't in the mix, but lost almost $2M. I imagine that there were some changes.

It should be interesting this year, since the cost reporting period is over and the figures should be posted soon. For those interested, AHD.com is the website.

My questions are many, but here is the predominate one: Do they really expect to turn around a hospital with some paint and TVs? That isn't the problem, but let's see what happens....

Your Comments are Welcome...12/15

It's hard not to hear the comments when you mention that you work at PRMC. I've heard of more incidents involving patients in the last year than in the previous six. Some have been relatives, some have been the actual individuals. E-mail them or if you want it as a comment, just comment. This is one forum in which complaints are asked for, and not swept under the rug.

Additionally, if you have a complaint in general, this is seen by Essent corporate at least once a day, most days six or seven times. Some execs even check it after hours. Trust me on this one. They are very aware of this blog.

If you mention that you don't want any identifiable information included, but in order to make the point to me, there are certain 'tells', that's fine. I'll use what I can, and if it can't be told without identifying you, then I just add it to my understanding of what we are facing.

I was asked why radiology was a hot-button issue here? You go with the gold. The topics with radiology were producing more comments than anything else. One post got 77 comments (and the comments are the best part!) If nursing was commenting more, we'd probably have a broader mix. But with RRVR even making the Paris Snooze, you go with success. There has only been one other that has been better (104), and that was a physician lambasting the medical community for sitting on its hands. Got to admit, there aren't too many that draw that kind of attention.

I will have some financial data a bit later, dealing with Essent's balance sheets. We will see how those go over. Just a few of the basics. All public domain, or subscription, but immediately available to the public for verification.

For the Beancounter in You...11/29

I guess I was too harsh on the bean counters, since I did get several replies defending their honor. A few observations were made that need the light of day, as to why Essent and Paris weren't the right mix:

1. Essent didn't have the assets to be able to swing this large an endeavor. They were very exposed coming into this deal, partially because of a poor evaluation during the 'due diligence' period. They had no idea of the magnitude of what really needed fixing.

2. Short term goaling. Corporate put them on a fast-track schedule, with milestones in the monthly/quarterly timeframe, rather than planning for the long haul. Sort of the difference between Japanese and American corporations: Japanese take a longer approach, while American corporations are more instant gratification driven.

3. Lack of real understanding of the politics of the situation.
They had no real concept of the animosity between the "Holy House" and "Big Mac" crowds, and how it actually impacted Paris healthcare. (Note: the quoted descriptors were not mine, but they seemed to illustrate the point....) Additionally, the dynamics of the physician groups that had formed were foriegn as well.

4. Inability to adjust to the situation. Despite descrepancies in their conceptualize viewpoint and reality, they insisted on staying with the original plan and milestones, forgetting that feedback, adjustment, and re-evaluation are important steps in a project.

5. Mis-evaluation of the area's labor pool. In metro areas, there is always a supply of staff, due to the population base. But, in the Paris area, there are a couple of fallacies in that equation: There is a smaller population and limited draw to the area. The metroplex pays far better. Why drive the same distance to one and get paid less? It's like what put some of the nails in McCuistion's coffin: A Dallas-based management team that assumed the business climate was the same as the metroplex, and implemented policies that drove away their physician tenants.

And the result? Patients are leaving in droves. Shuttle bus services to Texarkana, Tyler/Longview, and Dallas are having to buy more vans. (Maybe Essent invested in those!) Services and procedures that we could previously count on are here no longer.

All we get in return is a visit from a military dictator, who meets with the hospital CEO--probably sharing tips....

Turf War...1/9

What's happening in the so-called war between out-patient radiology and "Red River"? Seems as if the imaging center wins by default. This is not an exclusively Parisian situation, but it does impact the financial health of the hospital.

Typically, studies help spread the fixed costs of a department. When the number of studies for the hospital day shift is only 50 or 60, the result is a net loss per exam. Right now, they should be coming into their heavier census period, but if out-patient studies continue to go down, that won't help them.

What is the solution? For Essent, the automatic solution is to cut staff, one of the largest costs. How does that affect the new graduates appearing in December? It can cut in several direction: Hire the top guns in the new class, paying them entry level, and raise the performance bar to the existing technologists, hoping attrition would create openings and lose some of the higher paid staff? Or not hire any FTEs (Full-Time Employees), merely keep a supply of PRNs on tap to fill the peak periods through May. Or, just cut staff.

However, the solution may be taken away from them. The new class has been working in several different clinical settings, and has seen the differences in facilities. They might opt out of the PRMC setting for other markets, should that be viable for their situation.

Say AAAHHH....11/15

We're all healthcare professionals, aren't we? Okay, except for the beancounters, I mean. Which means we come to work, sick or not.

Personally, I hated going back to designated sick days--PTO was the best incentive to make it in no matter what...that way I could tack on a few extra days to a vacation that otherwise wouldn't be there. For Christus it was a good deal, they had less unplanned absences, which meant better staffing effiency.

Retrogressing to sick days opened the gates to people taking un-planned-for absences, rather than scheduling time off. Essent's new policy is slap in the face to anyone with children, an ill spouse, or chronic conditions which keep them from building up a surplus of sick days.

The policy (amended this month) is that in order to be paid for a sick day you have to have forty hours of sick time accrued at the time of the call in. To be paid on the second day if you are sick you have to have twenty hours accrued. So, if you have an extended period of illness, come back to work, and have a relapse--you won't get paid for the first day if you don't have a week's sick time banked! If you didn't have at least half a week, you wouldn't get paid for two.

I have plenty, but I know several people that this would knock to their knees. I would venture to say that the northeast doesn't have to put up with arbitrary B.S. like this--because of the union contract. I can feel myself drawn to the dark side....

Retaliation...11/10

Commenting in the blog has been risky, but the courts have made it likewise for employers. A dismissal for cause is hard to justify on the basis of suspicion. In a right to work state, however, you can be fired for wearing the wrong style of shoes. Right to be fired for any reason might be more appropriate. So the northeastern crowd has the advantage.

One of the things that I was referred to was a legal guide for bloggers, which may turn out to be quite handy.

But, as they say: "Don't worry, be happy...."

Free Speech...or is it?...10/31

Apparently, according to sources, Essent has filed a complaint with the Texas Attorney General's office against the blog. The Attorney General is progressing with an investigation as to validity of charges.

While not a public company, Essent certainly has a public presence. Everything published in the blog is available on the net for the price of a connection. Generally, links are included. Any comments from individuals, with the exception of spelling/grammer, are published verbatim.

But, who knows, they actually might be able to shut it down. Hopefully not. Based on the popularity and contributions from readers, it seems needed.

If it is taken out of play, it would seem that freedom of speech is becoming very limited in the state of Texas!

For the Best...10/19

I guess it is for the best: an interventional program that was top-notch, reduced to "we do most." If you saw the original write-up for the interventional suite, it seems a shame to have all that potential going to waste. But, the alternative is to have radiologists working in unfamiliar settings, with unfamiliar staff and equipment, doing procedures that they haven't practiced in possibly years. Not what I would call a best case scenario....

But, here is what others are saying:

Check it out! Essent updated the website. They removed all of the procedures that they no longer perform in the radiology department. So the listing on this site now is the only record of what used to be available. Still the site says, "All radiologists affiliated with the program are board-certified." Technically, this is true since there are currently NO radiologists affiliated with the program. It would also be correct to say that "All radiologists affiliated with the program shoot themselves in the head each night before going to bed." This would be equally true because once again, there are NO radiologists affiliated with the program.

Regarding all of those wonderful nuclear medicine scans that the new website mentions...funny that it doesn't mention that none of them can be read after hours on call. So if the ER doc needs a V/Q scan...better wait until tomorrow if you want to get it read. As to the after hours sonography...better hope that the sono tech knows what he/she is doing. There will be NO radiologist to consult until sometime tomorrow, and that radiologist may be in another state!

And, I've heard that Paris Imaging is jumping in the Nuclear Medicine market with their own camera. Sounds like the hospital is going to get a run for their money. So all the outpatient studies will be available in a new facility, and generally cheaper. Too bad our insurance (the hospital's) won't cover the entire cost, but you know, I figure it would be worth the additional expense....frank

...and Then There Were Two....11/20

MRMC narrows list of suitors to two
Phoenix Staff Reports

The Muskogee Regional Medical Center Board of Trustees selected Community Health Systems and Capella Healthcare Inc. as final candidates to run the city-owned hospital.

The board voted unanimously Friday morning on the two suitors after emerging from an executive session to narrow the list of choices.

Board Chairman Chris Condley said that some time during the next 10 to 12 days, each candidate will sign a letter of intent stating they want to move forward toward a definitive agreement.

After the letters are signed, the hospital will have the right to conduct more research on each company, and the companies will have the right to investigate the hospital.

Condley said the board hopes to decide on one company before the end of the year.

Guess Friday the 13 was bad luck for Hud!

yer out!

Out of date...Out of their minds....10/31

E-mails keep on coming, and this is a beaut. Actually, it combines a couple....

Have you checked out the website that Essent maintains on PRMC lately? The information is so out-of-date that it is laughable. Still, PRMC's own website documents the services that USED to be available in the Radiology department rather than what is actually available now.

It is a sobering thought to realize that most of these interventional procedures
have been shut down by the actions of Essent and are no longer available--to the detriment of the patients:

-Angiograms, Vena Cava Grams
-Peripheral Angioplasty
-Arteriograms, Artery Embolization
-Arthograms
-Biliary Stent Placements
-Biopsies
-Cyst and Abscess Aspirations
-Intra-Vascular Stent Placements
-Nephrostomy
-Renal Infarctions with Alcohol
-Spermatic Venograms, Varicocele Embolization
-Compression of False Aneurysm
-Occluding Embolization
-Transluminal Atherectomy
-Transhepatic cholangiogram
-Thrombolitic Therapy for Dialysis Shunts
-Thrombolysis Therapy
-Percutaneous Gastrojejunostomy Tubes
-Renin StudÆ
-Ureteral Stent Placement

There was a time when the hospital was proud of its radiology department and loudly proclaimed its services and expertise. The procedures listed above were virtually unheard of in a town of this size. We truly were a "regional medical center".

Unfortunately, an outdated website is the only remaining evidence of how outstanding this hospital used to be. And how is this for false advertising: "Radiology Department Prevention and Treatment Paris Regional Medical Center's progressive radiology department performs all diagnostic and most interventional procedures. All radiologists affiliated with the program are both board-certified and interventional radiologists. Radiographers, members of the hospital staff, work closely with the physician radiologists. They, too, are highly trained and board-certified."

Gee...is there a true word in that last paragraph???

progressive radiology department --They must be kidding, right? Now,
how old is that equipment? How responsive is their servicing?

performs most interventional procedures. --Really??

All radiologists affiliated with the program are both board-certified and interventional radiologists --Tell that to all the doctors who order interventional procedures and are told to wait until next week or the week after next when one of the locums who does some interventional procedures might be in town.

Radiographers, members of the hospital staff, work closely with the physician radiologists. They, too, are highly trained and board-certified. --Where do I begin. Many radiographers are temps--hardly members of the hospital staff. Just how closely do you think that temp radiographers work with temp radiologists?? And don't we have some non-licensed/limited licensed techs employed?

Computerized Tomography
"Technically known as the Picker PQ5000V Spiral Computed Tomography System, the equipment lessens ...." There hasn't been a licensed Picker PQ5000v on either campus for years, per state records.... The picture is current, but not of a 5000. What they have is better, but it still falls far short of a current state of the art...but maybe their computer folks have more pressing issues to take care of---spying on employees comes to mind....

No More Famous Quotes???...10/19

Suitor tells MRMC he would answer questions, but not in public
By Donna Hales Phoenix Staff Writer
The chief executive officer of one of four suitors seeking to purchase Muskogee Regional Medical Center said he will answer any questions from the board, but not in public.

MRMC officials told the Phoenix last week it had “tough questions” for W. Hudson Connery Jr., president and CEO of Essent Healthcare, Inc., based in Nashville. MRMC set up a public board meeting Monday evening for Connery to answer those questions.

However, Connery wrote MRMC Board President Chris Condley on Sept. 29 that he would respond fully to questions MRMC told the Phoenix it wanted answered, but not at the public meeting.

Connery could not be reached for comment.

The board posted a note at MRMC saying the meeting was canceled because Connery declined to attend. In the letter, Connery told Condley that most of the questions already had been answered in information sent to MRMC.

Condley said the negotiations with suitors bidding for MRMC is in the analyzation phase and he could not make any comments. Condley also said it would not be appropriate for him to comment on any suitor.

Condley would not say why MRMC didn’t release Connery’s written reasoning for declining to attend the meeting.

Connery wrote that he was deeply concerned that the private proposal process — involving confidential exchanges of information by both parties — is evolving into a public proposal process.

Connery’s letter to Condley said he understood that “Essent alone of all other bidders will be asked in a public forum to answer specific bid or planning questions not publicly asked of other bidders in a process very different from that originally outlined to us.

“What’s more, to fully and truthfully answer these and other questions you may have, we must reference the private MRMC information you have provided to us, which would violate confidentiality agreements we have signed with you if used in a public setting. In brief, we believe a public discussion is an untenable process for both of us, and Essent cannot participate in it.”

Connery said he understood from a Phoenix article that some of the expressed concerns stem from Connery’s absence during MRMC’s recent visit to Paris Regional Medical Center, an Essent facility.

“It is our philosophy that the corporate CEO does not attend those visits to provide the visiting board unfettered access to local hospital leaders, physicians and community members. We believe that this practice provides visiting boards the best opportunity to see the value of our work,” Connery wrote.

It would appear that Hud is getting gun shy. Since it's a community based hospital, doesn't the community have a say??? Apparently not. As to violating confidentiality agreements, a signed waiver of liability & indemnity from the hospital would probably do the trick.

But, Essent is not a public company, and maybe they do have something to hide...as opposed to the hospital, which must maintain a higher degree of open records....

One would think that the undisclosed reason that he failed to appear might be this forum....

MRMC Board Votes...9/30

Muskogee Hospital Board Votes To Sell Or Lease Muskogee Hospital

AP - 9/27/2006 11:37 AM - Updated: 9/27/2006 11:38 AM
MUSKOGEE, Okla. (AP) -- The city-owned Muskogee Regional Medical Center will either be sold or leased to a for-profit hospital in hopes services will be expanded.

The hospital's board of trustees are considering proposals from Signature Hospitals of Dallas; Community Health Systems of Brentwood, Tennessee; Capella Healthcare of Franklin, Tennessee; and Essent Healthcare of Nashville, Tennessee.

Hospital officials say part of the sale or lease agreement will include requirement of no layoffs, no cuts in care for the poor and to keep the hospital's name.

Well, it appears that Essent has a chance, however, the conditions imposed might put them out of the running. What's the first thing they've done: Changed the name (guess they can't do their standard name contest. Wonder if Hud'll do the same speech?) Actually, the first thing has been the layoffs. They have, however, agreed in previous purchases to continue indigent care.

Northeast Essent...2/8

Greetings from the Northeast (specifically, Ayer, Massachusetts)

We are alive but not well! Recently discovered your blog and couldn’t believe what was before my eyes. The same management style has been felt by all current and former employees here at Neshoba Valley Medical Center. Let’s start by setting you straight on former CEO Andrei Soran. Andrei was a “puppet” for Hud and his “buds” and only had one thing in mind. The almighty dollar! Andrei and his senior “MIS-MANAGEMENT” team were and still are incompetent when it comes to their ability to provide quality care to the residents of these communities.

The same tactics of suspension and job termination are issued to quality care givers who speak to advocate for safer working conditions. Essent healthcare is unwilling and unable to provide a quality workplace and a standard of care which is the acceptable standard throughout the nation. It’s healthcare on the cheap.

NVMC is a 57 bed hospital which has never been at capacity and struggles week to week to keep 20 patients on the floor. The 6 bed Intensive Care Unit closes every other week due to lack of patients or no staff. Word is out in these communities to drive a few extra miles to Emerson Hospital, Leominster Hospital or the Lowell Hospitals to have a chance at a good outcome. One patient made a $1000 donation to a local ambulance service to bring him to a facility other than Nashoba Valley Medical Center.

The new CEO Steve Roach (previously the CFO) is a 33 year old bean counter who spends his time photographing employees as they drive up to the back door to punch in. These photographs are distributed to department managers with threats of written warnings and termination. All managers are required to park in a designated area of the parking lot “FOR MANAGERS ONLY.” The security department is often requested to run plates to be sure rules are being followed. The latest is PARKING TICKETS to any staff violating Essent’s parking rules. While all this is taking place patients have empty O2 tanks, antibiotic doses are consistently left over from failure to be given, PACS is down for 3 days, Human Resource Manager functioning as Nursing Supervisor on 11 to 7 shift, patients being boarded in the Emergency Room overnight due to lack of staff, hospitalists are no where to be found after 8 pm , 3 physicians resigned from the medical staff due to the poor quality of care. The “red sox” program for denoting risk to fall patients is a miserable failure. A visiting family found a patient lying on the floor yelling help with her RED SOX on as they came off an elevator.

If you visit the NVMC job postings you’ll see that in 2006 over 100 positions have been open. In the last year the CEO, Risk Manager, CNO, PT Manager, Pharmacy Director, and IT Director have all moved on. Essent’s philosophy of hiring new grads is in full swing up here also. However, it has come back to bite them in the butt. The Radiology Department is currently under investigation by the Department of Public Health for having an unlicensed and unregistered technologist working since May 2006. She has failed the registry 3 times. Essent is facing fines for each day she worked unlicensed. Administration had full knowledge of this and chose to ignore it.

The Board of Registration in Medicine is also in town. There have been 4 physicians on staff at Nashoba Valley Medical Center under investigation by the state for numerous violations. I can assure you it was not due to Esssent’s administration that investigations took place. It was ethical employees and patients who had to go out on a limb to protect the public. Essent’s policy was COVER IT UP. It became a police state in the hospital. If you were caught talking about the situation you were disciplined.

The bottom line is residents of the Nashoba Valley expect and deserve to have access to high quality healthcare. It is time for Essent healthcare to put Nashoba Valley Medical Center “FOR SALE” and give these communities a chance to receive the quality medical care they deserve.

So long from Ayer, MA “Where Excellence is (Non) Essential”

Essent is gold--fool's gold. Note to all the bean counters: Only one out of five hospitals has not piped up....frank

E$$ential Education...8/10

"School bells ring--are you listening?
Dodged the blame--who you kidding...
She's not out of sight, Bev's happy tonight.
Walking in an E$$ent wonderland."

Hey Frank,
You wouldn't believe who got the job as Clinical Director of the X-Ray program at PJC, none other than Frau Blücher!


So what if the Program Director took three times to pass the registry for CT, the Clinical Director has a BS in public relations (not radiology)--and was fired from the principal clinical site.... Of course they'll provide an exceptional educational environment! Don't you just love it!!

Quality in Education....

Well, the proof is in the testing. Looks like there's a lot riding on the national accreditation test for this first class. Since Mock was teaching there prior, it would seem that no one can claim to be uninvolved. Actually, I wonder how it will play, her being on-site at her old digs.... frank

Corrections are in red. See comments....

And the winner is...9/20

From the emails that have been trickling in, it would seem that Paris Imaging is the winner of this contest. Seems like only yesterday that administration was confident that "the boyz" were going to roll over and play dead...that they couldn't survive without the hospital...it might be the other way around.

Fact: This is the time when out-patient services should be loaded up...apparently they're talking about flexing (forced use of vacation time) staff.

Report turn-around time has become ridiculous. Morning radiographs might be read by the following day. (Paris Imaging has what, an hour delay? Definitely by the end of the day.)

Interventional studies are so erratic that they might as well close the suite. From one week to the next, they don't know if the radiologist that magically appears will even perform the studies. Speaking of the magic, seems like the confirmations are a bit slow in coming from the locum groups....

A lot of studies are not able to be done in the offshifts. Let me take that back, they are able to be done...but not read! VQ scans or anything from Nuclear Medicine that is done from 5PM to 7-8AM just sits...as well as plain films, and sonograms. Now that means that the physician that orders a stat study better be prepared to come into the hospital and read the film himself, and, if it is within the scope of his practice, he's responsible for doing so, since he made the determination that it was stat.

Security of the PACS is a joke, with the ability to look-up a valid password in Meditech! Apparently a tech was suspended for looking at a study that was verbotten...yet was not even on campus!

So, if you want to wait a day for your reading, be treated to an early-garage-sale appointed department, go to the hospital. If you like fast turn-a-round, clean, new and comfortable waiting areas, go to Paris Imaging...most of the docs do...you should, too.

Socialized Medicine...10/4

Nurses, teachers 'in crisis'. Still dedicated despite hardships, survey finds.
Kathryn May, Montréal Gazette, August 25, 2002

Canada's nurses, doctors and teachers are the most committed, overworked, stressed and politically maligned workers in the country, a landmark federal study of nearly 31,500 working Canadians indicates.

It found that those employed in health, education and other social services work the hardest and longest but feel the least appreciated and believe they are unfairly blamed for mismanaged systems. Linda Duxbury, a co-author of the National Work-Life Conflict Study, said the health and education professions have been so badly "devalued" by years of job cuts and poor labour relations that the country's schools and hospitals can't keep or attract workers. ...

While a universal healthcare program may seem to be a good idea, those that have it have significantly less healthcare availability, those in the professions feel less than appropriately appreciated...and when has any government program come in under budget?

Breakfast...for a Price...10/12

A couple of months ago, Sharon Hospital was nice enough to solicit campaign contributions from hospital staff and physicians for a political fund-raiser (breakfast) at the hospital. $500 was the asking price. All on hospital stationary.

The recipient was labeled as a "true friend" of the hospital who cut the red tape in allowing the first (and only) conversion of a not-for-profit community owned hospital to a for-profit entity.

"The letter may have violated several federal election laws: While a for profit corporation may hold fundraisers for politicians, they are prohibited from making donations as a corporate entity unless they register as a political action committee. A corporate PAC would be allowed to solicit campaign donations only from executives and stockholders, and a solicitation letter must include a statement that employees will not be punished if they don’t participate."

Politics as usual?...the affair was cancelled.....

Heck, why can't we all be like Hud...his political contributions totalled $17k in '04 and '06 cycles. And, he contributed $5k to the red-tape remover. (Hal Andrews added another $1,250.) It will be interesting how much is donated in this off-year election

Fact or Opinion.... 9/6

I received an email that pooh-poohed comments as conjecture, rumor, and less than factually based. They wanted specifics. That presents problems:

• To comment on the blog, with specific facts about a situation requires putting your butt on the line. (Although I've tried to keep identifiers out of publication.)
• People have been suspended for commenting, logging into, or promoting the blog.
• One was supposedly fired for not being able to stop the information outflow.
• Phone calls and computer use are subject to monitoring.

Heck, when just mentioning that they are short-staffed can get a suspension, it kind of takes the wind out of your sails.

The popularity of the blog indicates that it hits a nerve...Essent ( both here and corporate) logs in daily, and so do healthcare organizations from all over the country. I don't know if it's to commiserate, or to gloat...or to see if they are reflected in any of the comments that are so visibly displayed on a platform that has had over 77 thousand hits and is referred to by blogs in several other countries.

Somehow I think it's all of the above.

Cut at any Cost.. 9/2

I really don't know what's happened at corporate, but from what has been coming up in direct emails, it doesn't bode well for the whole. Seems budgetary cuts are the way of life, and what is the simplest solution?....Cut personnel.

The events described in this blog have never seemed remotely close to how the Merrimack Valley Hospital was being run. The MVH folks were mostly proud of how Essent had turned the old Hale Hospital into a respected medical institution in the Valley. The only people that were fired or laid off were people that largely deserved it.

It now seems that Essent has, with the hiring of a new CEO and COO, joined the rest of the Essent hospitals by putting the value of employees at the very bottom of their priorities list.

In the past, the administration would not even consider lay-offs as a means to remedy a poor earning quarter. The new COO has been heard boasting in the hallways of his prowess at his former jobs at slashing employment and saving the day. If the rumors of 50 coming layoffs are true, it would appear the new CEO has been slapped around by the Nashville crowd sufficiently to consider layoffs the quickest way to their dreams of how much this facility should be earning.

Hopefully more to come as events unfold but sign me: "a soon to be ex-employee"

Personnel cuts only work in the short term--as many companies have found. Now, what begs the question: What are they getting ready for? A buy? A sale? Or did they over commit with their promises to the communities in their building programs? To make a new hospital, are they robbing Peter to pay Paul?

As I said, personnel cuts are a fast fix for the lazy. Finding root causes of expenditures is harder, but longer lasting. Thinking out-of-the-box might be cliche, but it would seem that their CEO/COO team had found a nice corner of theirs to hibernate in.

Safe Staffing... 11/20

As long as we're plugging national issues that are coming up and affecting Essent and Paris, let's hit Safe Staffing. I say Paris, rather than PRMC, because it isn't just for nursing, it's for the EMS, Fire Dept, and Police as well. All those whose jobs can directly save lives. This isn't unique to Paris, but we seem to ignore solutions that have been found elsewhere.

We demand more of the community--be it social services, EMS, Fire, or Police departments, but we forget that these things cost money--and the money eventually comes from us.

Are we our brother's keeper? In some cases yes, as well as their parole officer, their jailer, their property's savior, their lifesaver.... If we accept that, then there is no choice...you pay for those services. And, since the payment is from property taxes, it is equitable, based on the value of what would possibly be lost...from fire or theft. If we wish additional staffing, than we need to pay for it as well.


But what about medical staffing? When does it impact on the lives of the patients? Nurse Safe Staffing is an issue that is being pushed in most states...but not California.... Why? Because it's already there.

The whole idea is to staff appropriately so as not to force overtime, to avoid using temps that are unfamiliar with the patients and facilities, and to create the cohesive team that is needed in the life and death situations they are faced with.


California adopted a Safe Staffing initiative, and amazingly nurses are retained at a higher level, more students are choosing the nursing careers, and hospital mortality rates are decreasing in many areas of care. The naysayers forecasted doom for those hospitals in California, but apparently none have been forced to close because of the initiative.

"Numerous prestigious medical and nursing journals have concluded the most important question a patient should ask when entering a hospital is, “How many patients will my nurse be caring for?” The answer can have life-or-death consequences."

"The Journal of the American Medical Association reports that the more patients a nurse has to care for, the more likely that serious complications or death will ensue. The study found that each additional patient above four that a nurse is caring for produces a 7 percent increase in mortality. If a nurse is caring for eight patients instead of four, that is a 31 percent increase in the risk of death. The conclusion of this study was that legislation to regulate RN-to-patient ratios was a “credible approach” to improving patient safety and ending the nursing shortage."

...from the Mass Nurses Association

This kind of crossed over to Paris Needs A Super Hero 's turf, but Batman owes me one....

Specialty Hospitals Are Back! 8/11

Remember the posts about specialty hospitals? They're back! The moritorium has expired and according to Modern Healthcare, they are back in business.

"Physicians plan to build new hospitals in Indiana and Texas, resurrecting a recent trend of doctors owning hospitals that had flattened during a congressionally mandated moratorium against physician referrals to facilities they own, a moratorium that expired Tuesday."

There are several groups in town that have explored possibilities along that line, and with the possible Medicare cuts January 1st, it might get a harder look by others.

Gay Rights? 8/17

Well, Radiology might be out of the closet, but the Massachusetts Nurses Association has filed suit against Essent for denial of healthcare benefits for a spouse in a 'same-sex' marriage.

“This is a blatant case of discrimination by an overzealous, out-of-state employer who purposefully chose to discriminate against their gay and lesbian employees when they could have treated all spouses equally and complied with their contractual obligation not to discriminate,” said Roland Goff, director of labor relations for the MNA, the union representing the nurses at Merrimack Valley Hospital.

“Without telling us they were doing it, and with the authority of officials living and working outside of our state, Essent went out of its way to alter a right granted to our members now depriving them of equal access to health care benefits simply because the affected members are gay men and lesbians,” Goff said. “This was a deliberate and unseemly attempt to discriminate against gay and lesbian members of the bargaining unit.”

Guess it's a good thing that Bice and David are headed for Sharon, CT.

Here They Go Again...9/8

Muskogee Regional Medical Center is Hud's next target (gets old, doesn't it, Hud?) Not terribly newsworthy except for the quotes:

1. "Anna Gene O’Neal, Essent’s vice president of Hospital Operations/Clinical Quality, said affiliation with schools and creating a good reputation has helped recruit nurses." Recruiting seems to be what they do--retention, or keeping staff, is what they don't.
2. "Founded in 1999, Essent is based in Nashville. They have purchased five hospitals in Texas, Missouri, Connecticut, Massachusetts and Pennsylvania. Connery said the company’s management style is based on good relationships with local hospital leadership." Not entirely accurate--they purchased six, and had to sell one--their first, or close it within two months. That accounts for Missouri. As for good relations, I guess that's in the eyes of the beholder....
3. "Connery said Essent would recruit physicians by doing a needs assessment and cooperating with existing hospital physicians. " Like with Red River, and a cardiology group which didn't make it, elsewhere.
4. Lastly, and the one I just take to heart: “We’re going to want to grow your reach to markets that you have considered secondary,” he (Hud) said. “Not just stopping the out-migration from your primary area, but redefining your primary area.” Wonder what our primary area is? It certainly isn't what it was before E$$ent got here, and out-migration...your name is Essent.

I had wondered why I had so many hits from Franklin, TN. Now I know. And, guess what, CHS is back as a competitor. This actually could get interesting.

Medicare Woes

There's a new monkey wrench in the Medicare mix--which may affect the E$$ent bottom line:

The New York Times reports (7/17/06) that the Bush administration is planning to cut Medicare payments to hospitals by 20 to 30 percent. It’s the biggest cut-back in Medicare history and health care providers say the results could be devastating, according to the Times.

The Feds say that it’s all about equity to patients regardless of their ability to pay. The new plan is to base payments on hospital costs instead of what the hospital charges. Reimbursements would take into account severity of illness and not just the diagnosis.

Here’s the kicker: The whole thing isn’t going to save the government any money, just move it around differently. As a result, many hospitals will lose out as payments for cardiac care, for instance, would be reduced. The government may end up cutting profits to specialty hospitals while hurting non-profits and research institutions in the process, the Times reports.

There are additional changes coming to imaging facilities, and possibly to leased MRI/CT leasees, modeled after California's reforms. A whole lot of businesses could be feeling stress at this point.

Embarrassed? I am...8/12

I think the sentiments of this email are echoed by many.

As a former employee, that left because of illness, not E$$ent, I have one question: When is the community going to get involved?

Even with the high price of fuel, Pts. are going in droves to Dallas, Tyler, and elsewhere for care. Why? Because they have lost faith in the system in Paris. That is a very sad situation for our people.

At one time PRMC was a place to be proud of. I truly loved my job and the atmosphere there. I have become ashamed to tell anyone that I worked there. The comments that are heard in the area are awful.

The employees can not do this by themselves; they need support from all of the surrounding counties.

Are the community leaders also on E$$ent's payroll? If not, PLEASE HELP to get this hospital back in shape for pt. care, not just dollar signs. If the quality of care had improved there would be no problem, but it has steadily gone down since E$$ent entered the picture.

This is affecting more than the hospital, people who used to come from different counties, far and wide, are now choosing to risk their life to get out of Paris, to a facility where they don't know anyone, and are far from home, just to avoid the chance that the rumors are true about the poor care given in Paris.

When these same people came here before, I'm sure they shopped with the local merchants. That just adds to the losses that most merchants cannot afford at this time.

Who do we have to approach to get the hospital back to taking care of our people????????

I wonder when a sense of embarrassment will overtake this community as a whole.

Ding-Dong...9/8

By popular demand: 'Nuff said.



Can you say "HAPPY FEET?"






Now if the scarecrow could only get a brain...rather than golf clubs....

All pictures and comments (on this page) are by request, and quoted.

Blogger has had an unusually high hit rate and may be having server problems. Email is still a practical solution.....

Apparently back on track. On to Oz!

A New Sheriff?...7/23

Rumors abound about E$$ent's financials, but here's a new one: The folks that Weatherford selected, CHS, is buying PRMC. If it's true, you heard it here first. If it isn't, I didn't say nuthin'.

In retrospect, I did have some nice things to say about them, but I wouldn't have thought enough to bring them here.... Guess it wasn't me, then.

Apparently they've been buying hospitals that are in the same category as what Essent has been, but with deeper pockets, they can afford to take the long view. Funny, they're out of the Nashville area, too, I believe.

Granbury has been one of their recent acquisitions, and despite a near boycott, have plans to triple the number of beds, and with a new facility/medical staff, they are betting on success.

This was a quickie, and not as well developed as the usual fare, but I just got the email, and had to punch it out. Stay tuned for updates, revisions, and flat out denials.... If true, this has scooped the Nashville Business News and a lot of reputable papers...oh yeah, and the Snooze....

Gone Fishing...8/4

Another heads-up from the radiology crew.

Yo, Frank,
Just wanted to give you the update on the new PACs system that E$$ent was so impressed with: apparently with over five users on it, it dumps and no one can see anything. Considering they have eight possible stations, that can be a problem.

Dr. Hobbs in his calm, unflappable fashion, said that it was not acceptable, after resetting multiple times the other night. This could be called the 'million-dollar muddle'.

The system was promoted by the manufacturer as being primarily for clinic use, and apparently they were right...or is it just the PACs administration??? Just call him "Crash".

Looks like Dr. Fish is on the road again. Got the heads up that he and another doc had a significant disagreement--leading to his dismissal. They've really got to get that under control.

However, there might be additional turnovers in Radiology foretold by a recent recruiting trip made by Frau Blucher (the Bit#h of Buchanwald), and two of the newbies. With multiple hires already in the pipeline, and a graduating class in December, it may not be who's being hired, it's who's being fired.

But the word is spreading, I was talking with a couple techs last week from ETMC and a hospital up in Arkansas, and they had heard about this place...and the blog.

Nice to know we’re appreciated! I've gotten comments from all over the state, as well as all over the country. In some Google searches, we're hitting the first and second results!

An Ode to ER Nurses...7/8

It takes a special nurse to be an ER nurse, and we may be losing a few more of ours. I received an email over the weekend, and you might want to consider it:

I just talked with another disaffected ex-E$$ent employee, and as we were discussing the ills of the hospital, he mentioned that the ER was about to lose a significant number of its nurses. He referred to it as the second wave, since we'd already gone through one change over.

I had heard that they were going to try to open the North Campus ER, and couldn't really figure where they would get the extra trained personnel, but now more were leaving? Not good.

On the floor, where it's generally calmer, and you can point a traveler to the various supplies, locations of equipment, etc. In the ER, you generally don't have the time to babysit, so a traveler is more of a liability than a help. Even someone floated from the floor, having a general idea of where things are, is not going to be in sync with the "flow" and what the standard procedures are.

A serious bottleneck was created when they were floating ER nurses to the floors--and got caught by an influx of patients. Now, they have a similar situation, only with nurses that they have to orientate as well. Want to bet on waiting times?

When I was there, there was always a few leaving, but it would seem like a good chunk of the corporate knowledge is walking out the door. But, since even Bonham pays nurses about $6 per hour more, the drive doesn't seem quite as far....

And for the lighter side, some truisms for those in the ER:

1. You Might be an ER Nurse if:
2. You consider a tongue depressor an eating utensil.
3. You have ever tried to identify what a patient ate last by examining the barf on your shoes.
4. You're at the grocery store, look down and notice you have at least 2 body fluids on you shoes and it doesn't bother you.
5. You've ever rolled your eyes when the 14 year-old says, "No, I've never had sex"?
6. You've ever told a confused patient your name was that of your co-worker and to HOLLER if they need help?
7. You've ever passed on the green stuff at the buffet because you are certain you suctioned it from a patient earlier?
8. You know it's a full moon without having to look at the sky.
9. You've developed a crease between your brows from trying NOT to inhale the various human secretions you've encountered over the years.
10. Eating microwave popcorn out of a clean bedpan is perfectly natural.
11. You've been exposed to so many x-rays that you consider it a form of birth control.
12. Your bladder can expand to the same size as a Winnebago's water tank.
13. You believe Tylenol, Advil, or Excedrin provides a large part of your daily calorie intake requirements.
14. You don't ask "frequent flyers" their history, you know it by heart.
15. You can keep a straight face when a patient responds, "Just two beers."
16. Your idea of a meal break is finishing your coffee before it gets cold
17. You've ever bet on someone's blood alcohol level
18. Discussing dismemberment over a meal seems perfectly normal
19. You believe in the aerial spraying of Prozac
20. You have encouraged obnoxious patients to sign out AMA so you don't have to deal with them any longer
21. You believe the government should require a permit to reproduce
22. You believe unspeakable evils will befall you if the word 'quiet' is uttered
23. You have used the phrase 'health care reform' to terrify your co-workers
24. You have witnessed the charge nurse muttering down the hallway, "Who's in charge of this mess anyway?"

And the saga goes on... 7/13

I received this email and had some qualms. I read the interview with the hospital's former CEO in the local paper and was going to email some of the folks that had been sending me the basis for my posts. Was curious about his departure. David Kreye was the new CEO, and I can't believe even he would do this. (Note: Apparently it was the facilities director that wrote in. I am duly corrected, and appreciate the input.)

My great uncle was one of the founding physicians at our little hospital and my father practiced there for nearly 50 yrs.

I managed the facility for nearly 22 yrs. and considered it my own and treated it as such. I guess you could say I cared about the place. Having grown up here makes you feel a part of a unique fraternity that honestly shares something with those who have come before.

At any rate, we were feeling the wolf's breath the past few years and in 2005 decided to look for someone to purchase us. Several look-sees came but no one bit. Along comes Essent in early 2005 and after much "due diligence" and careful research decide to buy us. Well the sale was consummated and on Oct. 11, 2005 they officially took over. The new CEO asked me to come up to his office that morning and said it was about to happen.

Not knowing what was in store I agreed to hang around. The first person to be escorted from the building was our HR person. In a brief span of time, almost 10% of our workforce was summarily erased from the books that morning. In short, they were not asked to join the new company.

Shortly after this a poll was taken throughout the hospital to create a new name for the hospital. After much suspense the official winner was "Southwest Regional Medical Center". Imagine that, a name overwhelmingly approved by the recently deposed board of trustees, the medical staff, the hospital staff, and the community at large! Think of it: A little hospital that has been known since the early 1930's as Greene Co. Memorial Hospital. WOW! what a leap of faith! Tim Leary would have been proud.

I could see the standards we have lived by would be slowly eroded in the name of "moving forward”. They do not like the speed at which the bureaucrats who regulate us proceed so they have chosen to circumvent their authority and proceed with total disregard.

The community meanwhile has recoiled at many of their activities and especially the continued release of many long-term dept. managers. These events have generated a great deal of doubt in their leadership. What would you think at seeing a want-ad for 3 new dept. manager positions at the same time from a hospital with only 54 beds? Perhaps this is the transition of converting from not-for-profit to for-profit.

I think our community expects more than this from an institution who has been a presence in various forms since 1907. I have seen many good people let go because they would not speak the party line. My concern is for the folks who go to this institution to receive medical care. Stay tuned, I think other things are in store for us...

I really have a problem with this: How someone could be so devoid of character as to parade the firing of staff before the administrator that had been there for over 20 years. Essent certainly knows how to pick 'em--how well we know, he was here first.

Oh, by the way, GCMH was a union shop. SEIU, if I'm not mistaken. Look for the union label....

Paris and Essent...6/16

Not that we can disassociate entirely from the rest of the E$$ent community (doesn't that phrase make you all warm and fuzzy), but I've probably spent more time than I should have on the other folks. However, it has gotten more corporate attention. It probably isn't going to be on Good Morning America (or 60 Minutes), but more people in the industry blogs are noticing our plight, and that could be what affects E$$ent's ability to grow: outside funding.

If the lenders had known that Crossroads was in such bad financial shape, there probably wouldn't have been an E$$ent at this point. That kind of begs the question: How profitable are they really, and how much is being siphoned from the profitable hospitals to keep the others looking good?

They have been cherry-picking, and scooping the really good deals. We weren't quite in that catagory, but they looked at us to do a couple things:

1. Doubling the number of beds. From just a numbers perspective, we had about the same number of licensed beds in our facilities as they had in the entire corporation.
2. Cash flow. There were enough blatant inefficiencies that needed fixing that they figured that most of the other problems could be fixed as easily. They were wrong.

But back to loans...you can't ask lenders to prop up losing hospitals, but you can ask for building funds, and point out that a hospital was doing poorly because of being 'under construction'. That would fit with buying a new PACs, while the portable x-ray machine in the ER looks like it's ready for the scrap yard...having two out of four x-ray machines down...or numerous hospital beds that can't be raised or lowered. And that would explain the need to transfer patients to floors that have working wall suction, rather than fixing the leaks...all while putting in flat-panel TVs.

Renting out floors at the North Campus kept that part of the facility from deteriorating from disuse, but it poorly disguises the fact that we formerly had two hospitals running at relatively high occupancy percentages--without the Dubois segment. Now we have empty beds even with that and having a South Campus floor down for 'renovation.'

The "Dallas drain" to Paris healthcare is significant, and damning. Next time you hear that your physician had surgery, or was hospitalized, ask them where they went...

Note: I used the South and North Campuses references purposefully. That's another thing they didn't 'get'....