In the Defense of Agency/Travelers/Temps...6/10

Had a lot of email about temps. There are good and bad, some are temps because of the situation like ours, some are because they like to be, and some are because they can't get hired any other way. This one seems like the first kind.

I read your comments about agency nurses and I would like to add some of my own, as well as steer you straight about we agency folk.

While it's true that agency personnel are temporary by nature, it isn't quite true that we have no vested interest in the patients in a certain facility. I am a former PRMC employee/refugee, currently working as an agency medical technologist. While I do not stay at any one place for longer than, say, 26 weeks, I do care about the quality of my work and how it affects the patients of the client facility I may be at. The same is true for most of the agency nurses. Granted, I have not yet found a place I care to stay permanently, and granted I have no desire to stay at my current post past my contract time, but one thing I pride myself on is turning out good work. I felt the same way when I was a former McCuistion employee, and even under the Christus and Essent regimes.

OK, so much for defending my career, now for some numbers:

I'm not sure how much agency RNs bring in on an hourly basis, but I can tell you that it costs the facility a pretty penny not only hiring an agency person, but add in the salary, insurance, per diem, car allowance, housing (paid for by the client in the fee paid to the agency) and whatnot, and it ain't cheap. Multiply that by all the agency folks contracted out by PRMC, and that's an awful lot of coin going out the door. As a contract medical technologist, I spent 20 weeks at the VA center in Augusta, Maine. I was told that the VA was paying my agency on average of 75 dollars per hour to have me there. I paid no bills or rent, my utilities were paid, and all I had to buy was food (and the occasional adult beverage if I desired), gas, and stuff for personal maintenance. RNs historically get paid more than medical technologists (could be all the P&Ming their group has done over the years), so I'll bet 75 bucks an hour is darn cheap- probably higher for the nurses.

Again, we are temporary- once our contracts are up, unless we get extensions we're gone. Training time (which takes up considerable amount of contract time), & money out the window, which has got to be invested for each new temp.

Here's an idea, radical tho it may be- spend the coin to improve the wage & bennie package, change the facility culture, and make the place more attractive to we allied health personnel to want to stay. I was happy during my time at McCuistion, and even tho we sniped with the St. Joe lab, we helped each other out when we ran short of certain reagents, let each other run specimens on our analyzers in a pinch, and had a friendly rivalry with little hostility. THR screwed that one up, resulting in the merger of facilities and eventual purchase by Essent.

It could be the only way to change culture is to change ownership.

I know- well, duh.......

PS- I know how to post to blogs and all, but the computer I use at work to answer email prohibits access to weblogs. My wife was kind enough to copy & paste some of the jucier parts & send 'em to me in an email. It's good to know that there are some other employees there in Paris that aren't bending over when Essent tells 'em to. Perhaps someday I'll tell you how I came to be an ex-PRMC employee, but for now keep up the good fight, and chinga Essent!

By the way, did I mention that I worked agency many, many, moons ago? When I was, I worked where I wanted to, because they wanted me. The ones that E$$ent wants...don't want them...Frank.

Pro-active: Suggestions for the Hospital...8/24

Okay, I'd like to see them gone, but if we could make it better while they are here....

How 'bout serious suggestions? That way they can't say it was never offered up to them ('cause let's face it, this is prime reading for directors--they might find out here first that they were fired!)

Yes, the picture has been re-used, but it was just too good and fitting not to...I did replace it with another.

This Bud's for You, Hud....5/29

A new quote from cyberspace:

"Paris Imaging Center is now open for business--and you know that Hud has to be really, really, chapped.... A professional, new, up-to-date facility, (on the loop, yet!) surely can't sit well. It's like a maple sap spigot that's jammed into E$$ent's side, and there are plenty more to follow.

When La Quinta made their announcement that it would be used for patient recovery and their families, for the new "physician's offices" next-door, I had my suspicions. I figured it wasn't going to be the standard family practice/ internal medicine suites. Well, it sailed through the rezoning with only minor contention from the other hotel/motel owners. I figure that outpatient surgery center is not the exclusive province of the hospital...something tells me it's a GI/Bariatric surgery center. When Dr Dickey dropped his privileges at the hospital, he divorced himself from the possibility of divided loyalties. Now he has privileges at Clarksville (and he's not the only one checking out the territory. You'd be surprised....)

I figure that it's not Ortho, and Cardiology is still looking at their own--and trying to sell space. Maybe general surgery, or plastics, but it doesn't seem likely.

No, I'd say it's a niche hospital/surgical center, and it's going to hit E$$ent hard--right in their insurance claims.

Now the question is: Who's going to buy the intervening space between the Imaging Center and the La Quinta? Maybe E$$ent will resort to the old Monty technique of buying the competition...after all, that's what got us into this fix."

A new victim in the making....6/4

Okay folks, got an email. One takes what comes through here with a grain of salt, so let's leave off the hysterics and reply with candor and tact. I was going to reply (and will, but in a comment), but I figured you all needed a chance. Personally, I think that they should run, not walk to the nearest exit from that experience.

Read with interest the blogs on E$$ent. Our Board is considering leasing to E$$ent or another group. What advice would you give? What questions should be asked of the company? It seems like you have some disgruntled ex-employees blogging - or who knows maybe they are enlightened employees. Your board had glowing reports about ESSEnt....

How has patient care changed? How has staffing ratio nurse to patient changed? How have physicians received the change? What has been patient reaction - your board seems to have only glowing reports? How has the census been since the change over? Have you seen an increase in transfers out of your facility? How many people did Essent lay off when they came in? Have they kept their promises for expansions and infusion of capital?

How did they handle accrued benefit packages (accrued days off, accrued sick time, retirement benefits, etc) upon take over. Did all employees have to reapply for their jobs? What happened to CEO, CFO, CNO, other upper management and department heads? What did they consolidate - HR, IS, Accounting, etc???? Is there planned union activity?

Any info provided will be helpful. Our employees are scared, concerned about their future, and upset that our Board is considering such moves. No one wants us to see us lose local control. But it appears that the Board is moving rapidly in that direction.

Is Radiology Self-Destructing?--6/22

Well, you thought they couldn't get worse, but look Virginia, they are!

Had a pt this weekend.... Multiple PE's shown on the CT....didn't get a report or find out for 6 hours... That's right... 6 HOURS

Good job radiology

And did we suddenly drop back to 4 hour coverage on the weekend? (That's four hours total, Virginia....)

The fudge factor doesn't seem to be working in radiology these days. (Nope, it's in MIS! I 'C' how it is....)

It would seem that the radiologist de jour turned up MIA this weekend... couldn't be located. They got another to come in for two of the 48 hours, and then split. Fortunately, they aren't too busy these days!

Larry, Moe, and Curley must be very proud... but oh! They don't even come in when their on call so I guess it doesn't matter!

May 19th should prove interesting for Radiology employees. A mandatory staff meeting has been called for that date.

Will it be another hour-long screamfest where Rad employees will be told how worthless they are? Or will Bev just finally go completely postal and gun them all down? Will they be told that she'd prefer temp techs to seasoned professionals? (Again.) Or will she start foaming at the mouth? (Kind of like the way she treats her hubby....)

Perhaps her superior will be there to quell rumors about his sweetie getting a job he is totally not qualified for and was posted for a fleeting second.

(Is this the way he gets out from under???)
It should prove verrrrrrrry interesting. Stay tuned. Film at 11.

PRMC: Reverse Polarity-- 5/29

If you've followed some of the links that are available on the site, you might have clicked on the ABC News dealing with infections. In it, the writer gives some standard advise on how to choose a hospital. This was a quote:

"A number of sites rate hospitals and provide information on diagnosis and treatment, the procedures that are performed, and how the patients fared. There are also "nurse magnet" hospitals where the best nurses work, the morale is the highest, and the hospital has the most resources. You want to be where nurses want to be."

Does this sound like PRMC? I haven't seen this many temps since working in a brand new medical center. There, they had an excuse: New hospital, immediate staffing needs. By the time they were one year into it, there were less than 6 temps working...heck, PRMC might have that on two floors in one shift!

The Radiology director has been quoted as saying she'd rather have all temps...but even the temps don't really want to stay. Seldom do they renew.

I had comments about a boutique hospital in Dallas. There, the staff is well treated, meals are gratis, and they actually get bonuses...novel idea. Their retention rate is almost 100%--no one wants to leave. Contrast that to here: Almost everyone is looking for an alternative....

Why does administration like temps? They have no vested interest in the hospital. They couldn't care less about policy, administrative responsiveness, or even much about conditions...because they aren't staying!

Our problem is that we are. Our families are here, we have roots, and to leave would be to be beaten by E$$ent. My worst fear is that family or friends would be subjected to "E$$ent care", or lack there of.

I don't think that they could ever rise to the standard of a magnet, nor would they want to. The telling reason is this quote from an article in Nursing World:

"Magnet facilities are required to respond to the complaint, and an immediate site visit is scheduled and investigation launched when the complaint involves a health and safety threat to patients or nurses."

Could they afford an "immediate" site visit? I think not.

Flattery?--5/1

I've had several blogs send for links to them and my policy is this: I'll put in a link, but if it is not reciprocated within a reasonable period, it gets scratched off.

The last two have been Citizens for Paris, and Paris Needs A Super Hero. Powerline 195 was promoted via email by a reader of both. (Heck, maybe Powerline won't be around all that long--if they win.) It has a single issue: Keeping the transmission lines out of Paris. The other two are more generalized.

I would imagine that this is about the only thing that E$$ent and I agree on: If it's bad for Paris, it's bad for both of us. The only thing that the Paris City Council has agreed on in my memory is the unanimous approval of the resolution against the transmission lines. Too bad they couldn't do the same with E$$ent! Wonder if Andrew will move if they put a 150 ft electric power transmission tower in his backyard?

Maybe if we all teamed up, we could get rid of Essent, the City Council deadlocks, and the powerlines. For the person with the "tunes that drive her crazy": "What a wonderfull world it could be...."

Oh yeah, the flattery question: How many blogs have started up in Paris since I started the-paris-site?

Note:
The caption might be: "The E$$ent Administrative Organizational Chart"!

Monster Mash--4/29

The annual Gala--A chance to be "seen" in one's finery with Hud and his bud.... Just what I want to do. On the surface, it looks great...charitable donation, mixing with the 'society' of Paris...who either don't have a clue, or don't care...because they're going to Baylor.

"But", you say, "it's going to a good cause...." Yep, one of them is: Nursing scholarships.

Paris healthcare? Maybe, but isn't that their code words for PRMC? Remember, they don't do anything for free. Make it a donation to the Agape Clinic, and maybe I would be less cynical...nah!

Grants are available for diabetes research, but, they are done on two criterias: who you know, or what you produce.

The Annual Golf tournament sort of fizzled: Who wants to buddy up to the E$$ent boys? Apparently not enough for a foursome. No, I can't say that, the board would make a foursome, and they're in bed with E$$ent, so I guess it would just be a case of rolling over one more time.

Speaking of the board, Gene is the one that's pushing the Gala. After all the history, it would seem like he's still right at the forefront.

If you really want to help a student nurse, there are probably scholarships that could use funding. If not, start one. Call it the "Paris for Excellence in Healthcare". Slap conditions on it that they'll have to pull a 3.0 minimum, and that they can prove financial need...I'll contribute. Heck, I'd put a link for a PayPal contribution.


Just say NO! to Hud and his bud.

Code Blue??? or is it?--4/24

This is a long post, but important. Bear with it and realize this is a game stopper. This was another email that I bounced off a couple folks and then decided to publish in its entirety.

PRMC has to install new portable telemetry monitors. When the employees ask, no one seems to know what kind of heart monitors the hospital has bought, nor when they are going to be installed, or where they're going to install them. Rumors abound, of course, but no one seems to actually know. Of course, biomed and the former assistant CNO and director of goodness knows how many departments went somewhere to learn about the monitors, but, of course, one of those two people has now left PRMC.

The general plan seems to be to install these monitors that only one person in biomed knows how to work on (which is also something that currently happens, even with a system that's been installed for quite some time), remove the telemetry technician from ICU, and consolidate all telemetry monitoring in one place with two telemetry techs. Currently, ICU has a telemetry tech to watch only the ICU patients, and the other telemetry tech monitors all other telemetry monitors throughout the hospital (excluding the emergency room), as well as the cameras for the stepdown beds.

IF all of the portable monitors were all present, this would have the hospital telemetry technician watching approximately 55 heart rhythms, 13 cameras, and the 13 stepdown monitor's blood pressure and oxygen saturation readings. (But about 20 portable units have gone missing.) This is, of course, too much, so it would SEEM to make sense to combine the ICU telemetry and all other hospital telemetry and split the number of monitors between two technicians. The problems that this consolidation would create are actually numerous, and affect patient care.

At this point in time, the hospital has already acknowledge that there is a large communication problem that affects the efficacy of the hospital telemetry tech. The hospital telemetry tech sits in a small room (affectionately termed "the hole") and has the un-enviable task of sitting in a chair for 12 hours, begging the 3rd floor or ICU nurses for breaks, and having no way of effectively communicating with any other floor than 3A. Of course, currently, the only other floor that is allowed telemetry monitoring is 7A, as telemetry overflow. This is exists for a couple of reasons. 6th floor doesn't monitor telemetry because there's been something wrong with the telemetry system for that floor every since it was installed on the re-model. 4th floor doesn't monitor telemetry for a reason that the telemetry techs were never told of, but it may have something to do with a delayed Code Blue on a patient due to poor communication between telemetry and the other hospital floors.


The OTHER reason that telemetry monitoring has been reduced to only 3A and 7A is because there is a serious lack of nurses who actually know how to read a heart rhythm. Apparently, this is not a requirement of nurses who have to take telemetry patients. It is not an uncommon occurence for 7A to have no one who knows how to read telemetry, and only one or two nurses on 3A (the cardiac floor) who know how to read it. Add to all of this, the fact that the currently telemetry tech staff (both hospital and ICU) have very little training beyond the heart rhythms themselves. The telemetry techs are all perfectly capable of reading the heart rhythms, and identifying problems, but they have very little idea of what to tell a nurse is the biological reason behind a reported change.

So, the telemetry tech doesn't know, the nurse doesn't know, so somebody needs to pray that there's an experienced cardiac nurse to ask readily available. If the nurse doesn't understand that there is an importance behind the telemetry changes reported to them, then they are unlikely to follow an appropriate course of action. And, quite frankly, there are few of the staff nurses left who are going to take the time to search out someone who would know what to do.

Also, the proposed change would lead to problems for ICU and the patients there. The ICU telemetry tech would no longer be "on-site" with the patients. The ICU tech monitors rhythm, blood pressure, and oxygen saturation on all the ICU patients, but there are also other invasive lines/readings to monitor, such as arterial lines and Swan-Ganz readings. The hospital telemetry tech has never monitored these, except for a few arterial lines that are quickly discontinued on stepdown, and has no training on what they do and/or should read. Also, except for a few stable or non-titrated (which mean the medicine is not supposed to be increased or decreased), the hospital telemetry technician has very little experience with the common IV drips used in ICU. Dopamine affects blood pressure and heart rate, Cordarone affects rhythm, Cardizen affects rhythm, Natrecor is for CHF but can have a bad blood pressure side effect, and Nipride affects blood pressure. These are the most commond drips used, and if the person monitoring the patient doesn't know what they are, what to watch for, and what they do, the patient isn't being monitored properly.

If the ICU telemetry tech is removed from the ICU setting, then they will more than likely be unaware of what drips the patient is on, or how they are being titrated, so they will not know what to look for. The ICU nurses monitor their patients very closely, but they do have at least 2 patients usually. As happened when the telemetry was combined before, no one calls the techs to tell them about admits, drips, or patient changes. And how is the tech going to contact them in an emergency? Usually the nurses are on top of the situation, and gathered in the patient's room. So, that leaves the tech on the phone, no one answering it, and the tech having no clue if the nurses are in the room.

It's not a good move for the patients, it's been tried before, and failed before. If the problem is that the hospital telemetry technician is watching too many monitors, then, why not, when installing the new system, portion some into the ICU where they can be watched by that technician. Something like, ICU would watch ICU and 7th floor, and the hospital tech would watch 7A. Maybe not very cost effective, maybe not even feasable, but better for patient care than effectively ham-stringing the techs.

Casa Rio Rojo? 7/29--New Pic

Guess it's official, Red River Valley Radiology is moving...to the Loop! Despite being one of the most consistent customers of the hospital, the hospital (Essent, PRMC, or the powers that be...) have determined that they need the space...in a building that has noticeable vacancies.

Shame that the convenience of their location to the various medical offices (notably the old Sears and Brookshires buildings) was lost, but if you notice, most of the newer medical offices are moving to the Loop/195 area. In the long run, this will probably benefit the group, but time will tell.

It is amazing that the push to depose the family/locally owned business coincides with the arrival of a new PACs system, which will allow the hospital to farm out the readings to radiologists...in say India, Ireland, or wherever. It's also a shame that the convenience of comparing films brought from outside sources will be lost, or the ability for the physician to review those outside films with a local radiologist (which was a non-charged service.)

Renovation of the former Casa Ole is on-going, and by the looks of things, should meet the May 15th deadline. All they have to do is pick a name for the building...and keep up the service that garnered their move.

Okay, I had to change the date, since the move date changed. Besides, this one is going to go gold by June, I have a feeling....and you know, that lot next-door would make a heck of an outpatient facility.

Looks like they're going to make the deadline!

Boutique Hospitals--the Hows...Tax Day

Article excerpted from USA Weekend:

People often assume this 12-bed nest is only for the rich, says Jack Sternlieb, M.D., the boyish founder and director of The Heart Hospital. In truth 80% of his patients are on Medicare. "Full service hospitals are big white elephants," he says, "bogged down in administrative costs."

Specialty Hospitals:

Proponents of physician ownership of niche, or specialty hospitals, argue that it is a model that encourages innovation, which can lead to reduced costs and increased quality of care. Opponents argue that specialty hospitals take away profitable business from community hospitals necessary to service low-income patients, leaving general hospitals the poorest and sickest patients.

Legislation:

On June 8, 2005, with the expiration of the federal moratorium, a number of specialty hospital bills were filed to be considered by the Texas Legislature. SB 872 directs the Texas Department of State Health Services (DSHS) to study the impact of niche hospitals on the State’s health care delivery system. The law prohibits providers from recommending patients to a niche hospital (generally defined as surgical, cardiac, orthopedic, or women’s hospitals) when the provider (or immediate family) has a financial interest in that hospital. An exception applies if the physician discloses that interest to the patient in writing and informs the patient that alternative choices are available. The physician is also required to notify DSHS of any ownership in niche hospitals. The bill directs DSHS to conduct a study regarding the impact of niche hospitals on the financial viability of other general hospitals in the state. In addition, the bill establishes an Advisory Panel on Health Care Associated Infections to collect and report data on infection rates and process measures, effective September 1, 2005. HB 3357 requires an application for a hospital license to include the name and social security number of any individual (including physicians) who has an ownership interest of more than 25 percent in the hospital, or is a General Partner. The bill also directs DSHS to post the names of all the individuals named in the applications to its website.

The moratorium extension into 2007 for specialty hospitals slows the progress, but an outpatient surgical center that grows...has possibilities....

Whatever is going to happen better be planned now. I would estimate that a window of opportunity will exist briefly, and that those that submit immediately after the expiration of the extension will have the best chance of approval. I can forsee as well, additional stipulations and restrictions being added in the ensuing months.

Who can put it together?

I feel that it should be a consortium of local physicians, possibly with additional capital backing. Christus did it once, however badly it turned out:

If you will remember, Christus built the Outpatient Surgical Center as a for-profit enterprise, soliciting investment from the physicians, in an effort to garner revenues from the outpatient side of healthcare. The enterprise failed, more from billing problems and management than a lack of need. The buyout, by the non-profit side, was pennies on the dollar to the physicians, and Christus ended up with a surgical center at a discounted price, with no interest. Whoever said that incompetence didn't have its rewards....

I think we can do better! Possibly with the support, if not the help of the Texas Medical Association and the AMA. A TMA article sets the 2006 goals, including:

"Strongly oppose efforts to limit investment opportunities for physicians such as limiting ownership of facilities, equipment, and services to certain types of providers."

I guess it depends on your definition of strongly....Even Baylor has gotten into the act: "Even though Baylor and THR officials want the ability to partner with physicians and construct joint ventures, not all hospital representatives share that opinion."

Boutique Hospitals--the Whys...Easter

The "boutique" hospitals provide several benefits as indicated by the article that this was excerpted from:

Major motivators
Physicians seeking to build such a facility typically have two major motivators—control and economics, comments Ted Schwab, president of Sokolov, Schwtiqueab, Bennett, Los Angeles,a consulting firm that specializes in joint ventures and other arrangements with physicians.

Physicians want control over their work lives—where and how they perform their procedures and the staff and equipment they have available.

“If you talk to physicians who work in hospitals, one of their perceptions is that they are unlistened to,” he comments.

Boutique hospitals are profitable because they concentrate on “hearts, brains, and bones,” the most lucrative specialties....

Why should that matter here? Because not only is the mix poor, but the hospital treats physicians the same as the regular staff....ignoring or worse....

In some cases, boutiques provide resources that wouldn't be available in other circumstances. Lap-bands, plastic surgery, as well as the afore mentioned specialties. But, the patients are creating the market.

“The public wants and is demanding a friendlier, healthier, more comfortable environment.
We are basically bringing the concept of personalized care from the outpatient surgery center into the surgical specialty arena.”

And, with the current staffing problems, personal care is something that Paris has a lack of.... Next, the "Hows."
NOTE: More pulled from comments. They even included some of the references!

Joint Council on Accreditation of Healthcare Organizations (JCAHO)--4/28

Someone came up with an idea for a JCAHO post: where you can comment on any violations. Actually, it would help keep the hospital honest, and it would help the patients, and isn't that the whole idea of healthcare?

Rather than just cleaning up messes, and pencil-whipping the forms at the last minute, wouldn't it be novel to be doing it right all the time?

Keep your letters and postcards coming, folks!

The Board--4/22

I don't know exactly where to post this - but it must be said:
We are giving E$$ent all the credit for the straight running crap that has and is taking place since "Hud" came to Lamar county.

One wonders - what about Hud's "Board of Directors?" Are these not local "folks" with a sincere interest in our community?

I am led to believe one of two things: they are either blind - or integrity is a word with which they are unfamiliar. Does any one else have any thoughts on this?

That was from an email, but I had thoughts when they recommended Essent over HCA, and the recommendation apparently was on the basis of two things:

1. HCA wanted to disband the board.
2. The board membership is now 'compensated.'

I really feel better knowing that a retired football coach is on the board that determines my healthcare alternatives. Are the others equally as qualified? One only wonders....

Corporations have been jumping on the board of directors bandwagon for years--that's how the executives get the exorbitant salaries, and how board members get paid...despite not attending meetings.

Where is the outrage? Isn't there plenty when Congress votes itself a pay raise?

Hospital boards should be representing the community. When was the last time you saw a solicitation from a board member for input from the community? Probably the last time you saw a suggestion box in the hospital....

Radiology--Out of the Closet?--5/3

What fun x-ray is having. It's not every administrator that has his roommate working under him! All joking aside, the issue is: Can an administrator properly have a live-in work under their span of control. It would be interesting on the 90 day eval for the administrator to be perched over Mr. Neal's shoulder...watching....

But it sure does cut down the bit@hing in the fileroom, or does it? Guess it moved to the reading room where two female radiologists were "discussing" a difference of opinion--and had to be moved to separate rooms. What a comedy act.

But it ain't over, it seems that one of the cardiologists stroked out a patient a few days ago doing an incidental "drive by" carotid arteriogram...the brain is much less forgiving than the heart....

...and those emails just keep coming....

I just want it to be better....4/11

...my patients have been my reward.... I want...to be able to stand up for the patients, and do the right things, and not get beat up for it.

I just want it to be better. I know that's your goal too. ...a former PRMC nurse.

As I've said, the only way I can see the hospital(s) surviving is an employee ownership situation. North Campus is preferable because it would be a smaller-tighter running unit, and more practical in a later expansion.

The physicians have the possibility of pulling the greatest amount of funding, but the employees have to be vested to make it work and generate the loyalty, because right now, there is none.

One of the biggest faults that both McCu/StJo had was attention to detail, or lack of it when it came to finances. When they affiliated with larger corporations, their overall tone changed--the wrong way. Their philosophies were take it-or leave it to the physicians. In this area, that doesn't work. However, what compounded it was the fault--that was still there.

To make this work, someone has to be running billing like the billing manager from Red River; the people that are entering the orders have to be more mindful of the importance of their jobs, and be paid more because of it.

There are a number of things that could be corrected in the model that is in play, but Essent is firmly committed to the way they do business. And their arrogance is what will eventually be their comeuppance.

Rumblings from Within--4/1

I get a fair amount of email, a lot from employees that list specifics...that would get them terminated if I wasn't watching for it. But, then sometimes I get strategies, and pull ideas:

Date: Sun, 26 Mar 2006 23:03:17 -0800

Between you and me, I think that Hud has his hands full and he's not managing things very well.

1-6. --for later
7. Perhaps some pressure from the investors would promote another sale, maybe getting Capstone capital and Petra Capital (the Arcon investors out to the tune of $50 million) to talk to the current investors
8. The whole thing really DOES fall apart without Hud. If he wasn't in the picture the investors would force a sale of all the hospitals. I'm not saying he should be done in, but if we can somehow put some pressure on him, a few lawsuits against EACH of his hospitals may be enough for the investors to force a sale.
9. How many lives did he ruin with Arcon?
10. How loyal are his current executives? Can they go elsewhere, or are they also losers?

In order:
#7
Hud actually gives presentations on the changed climate for getting capitalization. With the changes in IPO requirements, I'd imagine that investment capital had to go somewhere, but the ROI has got to be far poorer.

#8
There is no way to really tell from the outside, but Vestar should have rumblings. The capitalization for the projects that E$$ent has committed to should be an indicator as to their willingness to prop Hud up...if the monies actually materialize. But, they have $80 million invested, so putting up some to save the current investment might be their plan. However, I'd look for delays in the projects.

#9
There were clinics that had just opened that year, so imagine starting work and being laid off with no notice. Nine facilities closed, I believe, and the month before, Hud was saying, "We believe that the company simply needs more time to allow its concept to mature and to grow its market share and revenue base." Time certainly wasn't on their side....

#10
Dropping one or two doesn't make you unemployable in their world, and I really think the exec shuffle is coming up. You may see some wanna-be's picked up--they would be the ones put into positions that their resumes don't justify. The trick is in the timing...too long and they might drop with the stock options, too short and it does them no good--and makes it look like the job was too much for them.

Several folks have dropped off the radar, and it might be other reasons, but generally they hit the news if only to calm investors. Maybe that's part of the reason for the "Hud and bud" show, crisis management.

Andrei Soran was top notch, then again, he pushed several programs that would have been excellent here...it's a shame he wasn't. It might be telling, however, that he bailed prior to committing to a building program that would have locked him in with E$$ent for the next five years. And, that he didn't take a corporate move-up. Or, he just wanted to stay in the Boston area... Framingham...in Feb???? Yeah, right! Butt deep in snow going around roundabouts!

The subject of unionization has cropped up. Fine, if we were in the Northeast. Here, we already have had two sales because of balance sheets. PRMC is weighted down with a lot of property that just isn't profitable. The insured/uninsured mix is poor. And now we throw in a union to deal with? This is a right-to-work state, and there are bound to be several opportunities for investment that don't have as many fleas. If E$$ent went defunct or just sold us, who would buy?

In a breakup, we would be far better in the long run...but short term...oh baby, those that live paycheck-to-paycheck would be slapped in the face--hard.

Sinking Ship?--4/24

There was a reference to a couple E$$ent folks leaving that got me wondering:
Hal Andrews and Joe Pinion were both players in the Essent matrix, Executive VP of Planning and COO, respectively.

Now, Nashoba Valley Medical Center's CEO is bailing in the middle of the planning phase for new construction. CEO Andrei Soran gave his two weeks notice.

I wonder....

Since it's a private corporation, there is no way to tell what options he loses by leaving. There is no open public record of their profit/loss--just to their investors...which were here this month evaluating their investment....

Probably a good thing....

Company Policy--4/3

Start with a cage containing five monkeys. Inside the cage,hang a banana on a string and place a set of stairs under it. Before long, a monkey will go to the stairs and start to climb towards the banana. As soon as he touches the stairs, spray all of the other monkeys with cold water. After a while, another monkey makes an attempt with the same result - all the other monkeys are sprayed with cold water. Pretty soon, when another monkey tries to climb the stairs, the other monkeys will try to prevent it.

Now, put away the cold water. Remove one monkey from the cage and replace it with a new one. The new monkey sees the banana and wants to climb the stairs. To his surprise and horror, all of the other monkeys attack him. After another attempt and attack, he knows that if he tries to climb the stairs, he will be assaulted.

Next, remove another of the original five monkeys and replace it with a new one. The newcomer goes to the stairs and is attacked. The previous newcomer takes part in the punishment with enthusiasm! Likewise, replace a third original monkey with a new one, then a fourth, then the fifth.

Every time the newest monkey takes to the stairs, he is attacked. Most of the monkeys that are beating him have no idea why they were not permitted to climb the stairs or why they are participating in the beating of the newest monkey.

After replacing all the original monkeys, none of the remaining monkeys have ever been sprayed with cold water. Nevertheless, no monkey ever again approaches the stairs to try for the banana.

Why not?

Because as far as they know that's the way it's always been done around here.

And that, my friends, is how company policy begins.

Nice catch, thought it needed to be up front!

To those physicians who continue to remain silent ...4/25

To those physicians who continue to remain silent about what is going on at PRMC... I say shame on you! E$$ent and folks like J.R. may have a Teflon coating, but you are just as liable and responsible for tolerating what is going on inside these walls as they are... if not more so.

This is precisely the time one must remember taking the Hippocratic Oath:

I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice.

…or were these just fleeting words, merely to suit the moment?

Do you think that E$$ent will support you when the walls come crashing down? When the lawsuits start? Will they even be here? Ask Wentzville, MO.

The doctors in this community MUST put aside their trivial North/South differences. They might have had some value prior to the merge, not unlike school spirit, but at this point the pathetic political tirade has gone on long enough! We all lost! Soon, none of us will have a place to practice medicine! Is that what you want..?

This is a pull from a comment, but is heartfelt. Years ago, I heard something about Pogo logic, and did some searching. Can't say if "the enemy of my enemy is my friend" quite fits, but this has to go to basic loyalties. The rape and plunder of the Paris healthcare system is all of our concerns, and I can't see that north or south means a lick of difference.

Would you let a loved one go through our system without monitoring? I wouldn't in any case, but now it is just plain scary. What if you are on vacation or out of town on business?

More and more of our patients' family members mount vigil over them. Transfers to Dallas facilities have skyrocketed for things that could well be treated here. They don't blame the staff, for the most part, only the administration. But that can change, given our tolerance for what has transpired.

There is a lot of griping, but little dedication to finding a solution. I challenge the physicians:

You enjoy the position of respect for what you have accomplished, and for the care you've given. Now it’s time for some leadership to appear, as well.

Do you enjoy the quality of medicine that is currently equated to the medical community as a whole? In your judgment, is this harm or an injustice?

Step up to the plate.