Thursday, January 31, 2008

Wishes and Hopes....3/5

Where lies the future of Paris’ hospital?

Staff reports
The Paris News

Published January 27, 2008

It’s been a long time coming — and it may very well be quite some time before we actually see it happen — but Paris Regional Medical Center recently announced that it was another step closer to what it calls “campus consolidation.”

Chris Dux, the hospital’s CEO, told employees a couple of weeks ago that the hospital had purchased two new heart catheterization labs and a 64-slice CT scanner. One of the labs and the CT scanner were destined to be installed within two months at the hospital’s North Campus, the former McCuistion Regional Medical Center. The new equipment is to be part of the hospital’s planned Cardiac Center of Excellence, a facility dedicated to the prevention, diagnosis and treatment of heart disease, providing a level of care previously only available in larger metropolitan hospitals.

As exciting as news of the advancement of the cardiac center is, the announcement that the hospital was another step further along in its long-range plans for the North Campus was just as exciting to the community at large.

As far back as the merger of Christus St. Joseph’s and McCuistion, Paris’ two long-time independent hospitals, into a single provider, hospital officials began to formulate long-range plans to make greater use of the facilities on the North Loop, expanding services offered there and building new structures on the open ground surrounding the main structure.

“Our long-term goal remains for Christus St. Joseph’s to relocate all services to the North Campus," said Monty McLaurin, chief executive officer of CSJ, as reported in an Aug. 8, 2002, story in The Paris News. The remark was part of a report on short-term relocation of services to the South Campus, a move designed to improve cash flow for the hospital.

When Essent Healthcare bought the hospital soon after, Essent officials went on record that they, too, saw the wisdom in eventually making greater use of the North Campus, with its open acreage and fewer busy city streets cutting through the grounds.

Dux told hospital staff at the meeting recently that the new equipment was “the first step in our campus consolidation.” He also announced that Essent had hired the nation’s largest designer and builder of healthcare facilities to assist the hospital with “a clear long-term plan for future expansion and growth of the North Campus.”

Such an announcement can’t help but make the people of Paris optimistic that Essent is prepared to do what it takes to make PRMC a first-rate medical facility. The hospital’s willingness to go forward with plans that will make best use of all available facilities should be encouraging to those of us who have watched the hospitals with a wary eye these past few years. We hope we are witnessing the first steps in returning Paris to its standing as a strong, stable center of regional medicine for Northeast Texas and Southeast Oklahoma.

Personally, I'll believe it when I see it- but if it happens, it can't be soon enough. The south campus is landlocked, and I don't believe Brookshire's is going to close its doors any time soon, so expansion there is out of the question. --anonymous

My take is: status quo. There are some minimum upgrades needed for the cath lab...minimum to staying open. Putting in a 64-slice CT at the North campus might be just to appease Dr becomes as unwieldy as the MRI when needed for a South Campus patient. By the time it would start to be utilized fully, it will be as outdated as the one it replaces....frank

Sunday, January 27, 2008

Another Lawsuit Appears....2/7

While not confirmed online, I received notice of another PRMC lawsuit, but this time with them as the defendent:

Jerry Dean, individually and on behalf of the estate of Wanda Dean v. Adam Gunder M.D.; Paris Regional Medical Center LP; EHC PRMC GP, LLC; EHC PRMC LP, LLC; Essent PRMC LP; Essent Healthcare - Paris Inc.
1/25/2008 208cv027

(It is a medical malpractice suit, alleging the person died from a heart attack after she was turned away from Paris Regional Medical Center's emergency center. )

What makes this interesting is Dr Gunder's pending departure from Paris. That and why a hospitalist is being sued based on an ER turnaway. I imagine we'll see in the months to come...frank

Current open cases are:

Ours, of course, the gang of 10 (John Does 1-10, Happy Hour meeting at Applebees on Fridays)



This one has a default judgement, but 01/17/2008 lists an "ORDER GRANTING MOTION FOR NEW TRIAL."

For an interesting read, search the courthouse civil database using "Paris Regional". (More times than not, dismissed by Plaintiff means a settlement prior to jury.) ...f

Quote from Martin Luthur King " The law cannot make a man love me, but it can keep him from lynching me". Most magistrates feel the same way.

Saturday, January 19, 2008

If You Do, Or If You Don't....2/6

Enough traffic has come back on the ER/CT issue that it gets its own post. One video tracker lists the 'reports' that are on the news channels. I solicited the following from some of those in the field:

Years ago, it was often said that radiology and lab was used to "rule out" this or that ailment because the doctor's didn't know how to make a clinical diagnosis. As a kid, I had right lower stomach pain and the family doctor did a simple blood test, pressed on the area that was hurting and told my parents to get me to the hospital ASAP and the surgeon would be waiting to take my appendix out. Today, it's lot's of lab work, plus a CT and then surgery. I think we can thank in large part of this particular dog and pony show to trial lawyers for driving up the price of a simple diagnosis. That's a whole different topic for another time!

On the plus side, CT has eliminated so many x-ray studies I couldn't count them. The numbers must be huge. Plus, the difference in radiation dose in a minimally invasive CT versus an angiogram (name your study) has to be significantly lower. And, many of these exams are performed on an outpatient basis eliminating lengthy hospital stays while recovering from such procedures. The diagnostic results are far, far superior to the "old" methods and techniques once touted as leading edge technology.

In a nutshell, CT may be over used by some physicians as a CYA defense, but on the whole, it's such a valuable tool that it has become the standard of care in medicine.
CT is a great thing. It lets us see into areas of the body that "the sun don't shine". And that's good. However, the over-use of radiation in any form is not. If you go into the ER, and I mean virtually any ER, and you have a cold, headache, miscellaneous pain, or trouble with your bowels (too active, or not enough), you will have an X-ray, and/or a CT. And, if you go there the next day, or a week later, the likelihood is that you will get the exact same treatment.

It doesn't mean that the treatment you will receive is bad, it just means that an emergency room is for EMERGENCIES. So, that's why you are directed to follow-up with your family physician. Without knowing you, the ER performs the same general screening time after time.
All xrays and lab tests are overused in the ER. I know this because I have a good friend who is a board certified ER doc and he would tell you: ER docs are the whores of the hospital. They are hired to do the dirty job that staff physcians don't want to do (ER coverage) but when the fecal matter hits the rotating blades, the staff docs won't hesitate to let the ER docs hang in the wind. So to cover their bottoms, they order more lab and xray, CT, etc than they really need, because it all comes down to our lawsuit happy society. CT is a great tool and it is over used, but it's either that or lawsuits every day and no more ER docs to cover.

Links to further reading:
Consumer Reports
The Washington Post
US News and World Report
Common Good
Sign My Cast

Monday, January 14, 2008

Back to the Obvious....2/4

They are no longer just looking at the heart hospital but moving the whole shabang to the north campus. They finally realize the logistics and the PR of the community [needs] a new fresh start.
According to the Essent, they're going ahead with the heart hospital...and possibly a new facility at the north campus location. Where is this influx of cash coming from? Probably the investors, who realize that unless they fund this properly, the whole ball of wax might melt. (Besides, no offers to buy.)
My question is will they actually try to get input from the people who will have to work there to make it a user friendly building or will they just go ahead and plow on thru with no clue to what a hospital is really for??
So, what should they consider when building this medical Mecca? Functional proximity, for one thing. Room size, equipment staging and storage areas, and planning for future technology/expansion (what hospital hasn't had to expand?) HIPPA requirements (avoiding the viewing of patient records at nursing stations). Flexible tasking of rooms and floors (being able to ramp up acuity levels as needed with appropriate plumbing [O2, suction, and monitoring] in place.)

Possibly even on-floor waiting areas, which while adding to the cost, are less costly per square foot than patient areas, and can be designed with an eye towards that inevitable expansion (if they are in it for the long term.)

Let's do it right, this time. Just please: Not another naming contest!

Friday, January 04, 2008

Econ 101....3/2

This was too good to pass up, so I left it as a comment, and used it in a post:

So far, this looks very promising. Those of us who are involved in this agree with the triad of Patient-Nurse-Physician comfort and confidence. I feel that the employees are THE biggest asset a company has (maybe it's only asset, since it's the only one that a company can control, as to mix and content). However, THE engine that drives the boat is the PATIENT. We must re-establish confidence in the system.

The LIST is so far a good one and will go a long way toward providing a foundation for guidance. Thank you, Paris.

Darn, he said what I wanted to. I could say 'ditto', but that's been used.

Obviously, in a free market society, the customer is king, within limitations. The hospital has two, if we simplify: Patients and providers. We have found out what happens when either or both are dissatisfied.

Essent bought into Paris because of a miss-interpretation of the market: Since we only have 'one' hospital, they thought they had a monopoly. They didn't read the hospital wrong as far as needs, they just didn't care. They figured that it was a closed market. That explains a lot. What they did read wrong was the patients.

Now I can get my head around the comment from so long ago: "We hope to make this 'the' hospital in the region...." W. Hudson Connery, CEO/President of Essent Healthcare.

I would say that this has been a learning experience on both sides....frank

Thursday, January 03, 2008


I was asked, in a comment, for your input (which we get in the afore mentioned comments) in a more ordered structure.

I am an interested physician who reads your blog. Would you consider asking your readership for a listing of grievances, in order to form a priority recipe, of those issues that employees, patients and physicians find most troubling with the current hospital's plight? This would help those of us who feel an intense need to help.

And, even if it were the hospital asking, I'd be willing. There is really no down-side. Let's keep the comments on this one limited to direct issues. "Administration is full of @#$%!" is not what I'm looking for; "Administration is hiding significant issues" would be. And then, possibly, an explanation.

This may not be as 'fun', but it certainly gives more credence to complaints, comments, and the blog.

We're sure to find a hot-button item or two to keep things interesting, and at the end will be a vote for priority. I would suggest that commenting would be the least revealing method, and if two comments reflect the same issue, only one will be added to the list.

There are several reasons to do this: Public awareness (of the blog as a venue.) Public recognition of problems. Public pressure. As for results: A large number of readers are employees, so an improvement in conditions has a direct effect. We are all potential patients in a life-or-death situation.

Based on the season:
He's making a list, checking it twice....


1. highly skilled docs boarded in emergency medicine;
2. a nursing staff with a modicum of competence and compassion;
3. better triage procedures;
4. a bigger ER.
5. better customer service
6. CEUs
7. better attitudes
8. follow-through with suggestions and complaints
9. support for the nursing staff
10. updating equipment
11. more personal contact by physicians with patient families post surgery
12. more respect for allied health personnel
13. more community involvement

Has anyone noticed that the majority of the comments are "people" issues? Many of which are low- to no- cost items. Three are high-cost (full ER boarded physicians don't grow on trees, neither do ER expansions, nor equipment.) Training personnel isn't cheap, but neither is constant turnover and "insured flight" (kind of like "white flight" from cities.)

You have to make this the hospital that its own staff would go to. How many of the physicians on staff (or their families) have you seen as patients?