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 Hashmi...it 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

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)

NONA HARRIS VS. KHALID SHAFIQ, M. D., RAPHAEL LUI, M. D., AND ESSENT PRMC, L. P., D/B/A PARIS REGIONAL MEDICAL CENTER


WORLDWIDE IMAGING TECHNOLOGIES-TEXAS, LLC VS. ESSENT PRMC, L. P. D/B/A PARIS REGIONAL MEDICAL CENTER


DEBRA BROWN AND IN THE INTEREST OF BRITTANY BROWN VS. PARIS REGIONAL MEDICAL CENTER
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 brennanlaw.com.au: 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.

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.

And:

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.

Last:

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
Wellness.com
Common Good
Sign My Cast

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!

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

Feedback....2/4

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....

THE LIST:

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
14. YOUR COMMENT

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?

What Rewards for the Whistle Blower?....1/03

Saw an article about an Atlanta Hospital which settled with the government for $26 Million in order to avoid charges of Medicare fraud.

The whistle-blower, a former employee, collected almost $5 Million.

One of the charges in the lawsuit is that I accused PRMC of Medicare fraud. A comment said that it cost the hospital over $250,000 to clear itself during an audit. If that money was paid to the government, isn't that like deferred prosecution? You're guilty, but they just want you to clean up your act? They don't say that a hospital is guilty, but you can draw your own conclusions....

I didn't actually accuse the hospital, but one might characterize a guilty conscious as being overly sensitive...and you wonder if someone pocketed about $45,000!!!

A heart attack at PRMC's Emergency Room....8/9

I received this as an email which had the patient's name and a lot of additional information as to his identity. I suggested that he consider it carefully and he agreed to my removing overt identification. However, I'm sure that his friends and the hospital personnel know who he is and who they are.

On the morning of Aug 1, 2005, I awoke about 4am at home with severe chest pain. It was an intense pain I had never had before.

Heartburn is something I almost never have, but I got up and chewed a couple of Alka-mints. The pain did not go away and seemed to gain intensity, so I woke my partner, significant other or whatever you want to call him. We have been living together for over 33 years and we have lived in ____ 22 years. He is also an ex-EMT basic. He had me lie down and administered oxygen. This helped a little bit, but I still had chest pain and trouble breathing. We decided I needed to go to the ER in Paris.

He drove me there and we arrived at 5:46am. Once in the ER, I sat at a desk while a nurse took my name, address, etc. and finally I was laid down and hooked up to a monitor with my blood pressure all over the chart and pulse as low as 37. When my pulse dropped below 40, an alarm went off and no one came in. I had to tell the nurse that it had gone off. She just looked at me with a blank look on her face.

Over several hours, I was given an Xray, an ECG and had blood drawn. I was left unattended all of the time while they worked on a couple of more patients that they said were critical. I was there forty-nine minutes before I was given nitro several times with no let up of chest pain.

I was never given any aspirin or any other drug of any kind. I was never asked if I had a history of heartburn or upset stomach. Dr Hobbs came in only once for a very short visit. He never listened to my heart or lungs or asked any questions about my history. My partner was in the room with me when asked by nurse Debra Crews who he was. He replied that he was my significant other.

After that statement, the atmosphere seemed to change and I was left lying there with only occasional checks on the monitor. Thirty minutes after shift change at eight a.m., Dr. Rowe came and stood in the door. He said I had GERD and gave me a prescription for a prev-pak ($300). He said my sugar level was high at 146. I asked what should it be and he said "140". Then he sent me home.

All the time Dr. Rowe was in the room he didn't come near me. He never examined me or listened to my heart and lungs. He never asked me any questions or medical history. I went home and the chest pain mostly went away late that afternoon. This visit cost the VA over $2,500. I believed the doctor and thought I had GERD.

The rest of the week was spent in agony. My arms hurt, my legs hurt, I couldn't eat, my blood pressure stayed very low and averaged about 70/50 which is really not enough for kidneys to work properly. By Friday morning, August 5th when I went to Bonham to the VA clinic, my blood was toxic and my heart in really bad shape.

They did an EKG and sent me by ambulance to the Bonham hospital to stabilize me before I was sent to Wilson N. Jones Medical Center in Sherman to the emergency room to be sent to a heart cath lab. There I had one stent put in and angioplasty. They left some blockages because I was on the verge of kidney failure, and more dye would have probably shut down my kidneys. I was told by the renal specialist that I came very, very close to death. Fortunately, I have good kidneys and passed the toxins quickly.

I was released on August 7th. Two days stay at the hospital in Sherman cost the VA $140,000. Later the next week, I was charged over $43 for a copy of my medical records from Paris Regional Medical Center to give to my VA doctor. There were no strips from the monitor in the ER in these records or doctor notes.

When I picked up the records, I asked if I was getting a copy of everything in my medical records and was assured that I was. The ECG in these records clearly showed abnormal heart functions.

On August 20th, I had chest pain and it felt as if I had a heavy weight on my chest. I called the Dallas VA hospital and was told to call 911 or go to the nearest ER. I told them I would rather take my chances on the road to Dallas than to go to the ER in Paris again. I went to the ER at the Dallas VA hospital and was admitted and had another heart cath on Monday, August 22nd. They put in another stent and more angioplasty. I was released on the 23rd with medications for my heart and will do follow-up in the cardiology clinic there.

I believe I was denied medical care for the heart attack I was having when I came into the ER at Paris Regional Medical Center for several reasons. First, I did not have the blank check of Medicare or Medicaid. Second, the personnel at the ER seemed to have no training in treatment of chest pain (heart attack) patients which is simply an aspirin and nitro glycerin under the tongue immediately. Third, Dr. Hobbs and Dr. Lowe acted like they really didn't care about me at all and neither listened to my heart, lungs or asked any questions and seemed to have no training in ER procedures.

I truly believe that if my heart attack had been diagnosed properly at the ER at Paris Regional Medical Center, I would not have gone through so much pain and agony and damage to my heart would have been minimal. By not treating me at all, Paris Regional Medical Center has taken years from my life and is liable for all medical expenses, ambulance trips, medicine and all other expenses incurred by the Veterans Administration clinic and hospitals.

So this is the organization that wants to put in a specialty Heart Hospital? Is this the same place that put up the signs for 'The Chest Pain Center'...and then didn't bother to inform the ER, nor staff appropriately?

And the gay issue...do all Essent hospitals have a problem with that? Personnel need to park their personal beliefs at the door. A patient is a patient is a patient...and they need your care. If you can't provide that, you need to get out of the medical field.

Yes, patients can have their own beliefs--and we have to respect them. That's part of the job. That's part of your training. 'First: Do no harm.' That includes 'by omission', as well.

Christmas 2007....1/18

As in the words of Tiny Tim (A Christmas Carol):

"God bless us, every one!"

Merry Christmas.....frank

Interest Revived?....1/11

You wonder if Essent is back up on the block. Searches from several corporations that would seem directed towards that end. Even the Aussies appear back in play.

And, it would be a good thought: Buy low.

I have been thinking about the Essent finances. The first significant loss was with Crossroads. Their version of buy high and sell low. Now that happened prior to the blog, although I did mention in the postings around Nov.

Even before the blog got rolling, MVH had serious problems, and their gay rights lawsuit didn't help that a whole lot. I think the Lahey Clinic has positioned themselves well in any case.

Sharon Hospital just keeps on producing.

NVMC is keeping its head above water.

Southwest (odd how a corporation with a Texas presence names a hospital in PA "Southwest") has their own problems. The blog didn't seem to really catch on out there, but there are several loyal followers. They just needed a cash infusion for an update. Essent was part of the baggage.

Paris. Paris had its own problems. How Christus was bamboozled into buying Big Mac is beyond me. Maybe the bean counters really believed that two hospitals that were losing money combined would lose it half as fast rather than twice as fast????

The 'due diligence' conducted by Essent missed an awful lot, and Monty was burying as much as he could at that juncture. On paper, the facility looked good (doubling the corporate beds!)...and yes, there were savings areas that were obvious. But, the duplication of services, the number of properties, and the mind-set were essent-ially ignored. When they looked at it rationally, the building of a new facility at the North Campus might well be a fantasy--unless a non-competitive buyer (like the VA) could be found for the South, or a re-designated use (rehab, LTAC) that could stabilize costs could be found.

The cuts were to be expected. The problem is, few realized that. The community was used to a not-for-profit environment, that could deficit spend. The attitude was it doesn't matter what we lose, we'll still have jobs. Essent didn't dissuade that notion during the courtship, but then there is hammer time.

Possibly the way to have gone, was to have involved the community more. But they are in a fix. The heart hospital sounds good "on paper" (again), but the proximity of Dallas, with cheaper pricing and newer facilities, puts a hole in that. Advanced Heart has been directing patients that way for years.

What will play out? Who knows. The lawsuit that Essent is pursuing (you thought it was over????) has to show two things: One, my posts were false. Second, by circulating said falsehoods, enough credence was given that financial losses were incurred. They are hindered by a several things, history, common knowledge, and their own policies.

Another Does Case....12/29

There is another aspect to the lawsuit. Essent does want to know who contacted me with 'tips'. Another 'Doe' case was in the media and finalized last year. That was the Apple vs Does, based on another blog and its sources.

May 26th, 2006

Huge Win for Online
Journalists' Source Protection
EFF Arguments Secure Reporters' Privilege for Internet News Gatherers

San Jose - A California state appeals court ruled in favor of the Electronic Frontier Foundation's (EFF's) petition on behalf of three online journalists Friday, holding that the online journalists have the same right to protect the confidentiality of their sources as offline reporters do.

"Today's decision is a victory for the rights of journalists, whether online or offline, and for the public at large," said EFF Staff Attorney Kurt Opsahl, who argued the case before the appeals court last month. "The court has upheld the strong protections for the free flow of information to the press, and from the press to the public."

In their decision, the judges wrote: "We can think of no workable test or principle that would distinguish 'legitimate' from 'illegitimate' news. Any attempt by courts to draw such a distinction would imperil a fundamental purpose of the First Amendment, which is to identify the best, most important, and most valuable ideas not by any sociological or economic formula, rule of law, or process of government, but through the rough and tumble competition of the memetic marketplace."

The case began when Apple Computer sued several unnamed individuals, called "Does," who allegedly leaked information about an upcoming product to online news sites PowerPage and AppleInsider. As part of its investigation, Apple subpoenaed Nfox -- PowerPage's email service provider -- for communications and unpublished materials obtained by PowerPage publisher Jason O'Grady. A trial court upheld the subpoena.

But Friday, the court said that O'Grady is protected by California's reporter's shield law, as well as the constitutional privilege against disclosure of confidential sources. The court also agreed with EFF that Apple's subpoena to email service provider Nfox was unenforceable because it violated the federal Stored Communications Act, which requires direct subpoenas of account holders.

"In addition to being a free speech victory for every citizen reporter who uses the Internet to distribute news, today's decision is a profound electronic privacy victory for everyone who uses email," said EFF Staff Attorney Kevin Bankston. "The court correctly found that under federal law, civil litigants can't subpoena your stored email from your service provider."

EFF worked with co-counsel Thomas Moore III and Richard Wiebe in this case.

For the full decision in the case.

For more on Apple v. Does: http://www.eff.org/Censorship/Apple_v_Does/

While this is a California case, if you will note, the our appeals court utilized the Cahill decision in their call.

My Rights??....12/21

Had a comment tossed my way that set me a bit on edge:

That's all you have to say about the appeals court decision? How bout a shout-out and a way-to-go for the 6th court of appeals making a stand for your first amendment rights?

It isn't just my rights, it's everyone's. The court's decision was in line with what I had been saying, and the opinion was well within my comfort zone: That I had an expectation of privacy, that if sufficient proof was rendered, the privacy would be set aside, however, prior to that I would have a chance to refute the presented matters.

Maybe it is because I take it for granted that the opposite had me so riled. However, the ruling set things right and all's well with my personal corner of the judicial system.

Should Essent pursue the case? It's their right. But, with the legal commentary that I've received, and my lawyer's counsel, I really don't feel that the facts support an adverse judgment.

But that isn't Essent's goal. Their goal, through the whole matter, is disclosure of my identity and what recourse they might have outside the legal proceedings. Kind of who-are-you-and-how-can-we-make-your-life-miserable.

I'm criticized for bringing up Holly as an example, but she is a PRIME example of what Essent has done and is capable of. And, for merely being suspected of being me, several employees have been fired, or was that just used as a public excuse? IT functions have decreased with the centralized data management, so somewhat less experienced and knowledgeable staffing is required.

Contemplate this: What kind of a split can the Paris medical community sustain now? In their current state, what kind of fence-mending can Essent provide, or would they even try? Is this whole thing merely to cow possible dissidents?



So much for a corporate showplace.

Warming Up??....12/18

Well, Essent's boardroom is probably seeing a bit more reds in their color schemes, considering the ruling handed down on the appeal. For one of the more confusing documents (not that I disagree, of course), follow the link. The ruling isn't confusing (pretty much what I indicated, a Cahill based decision), the formatting is. Don't know what the problem with my browser is.

While there's not singing yet, she's warming up in the wings.

Burning Rubber....12/12

For those who are wondering why the appeals court is taking their time, let's run through some statistics:

62% of cases are disposed of with in 6 months.
25% in 6-12
13% in 12-24
0% longer than 24.

Realize these are last year's statistics, but will probably hold. What complicates this case are the issues involved. A 'constitutional' issue, a somewhat obtuse decision, and statutes that support neither.

So while we're spinning our wheels, they are turning and just need a little traction. What might render the case moot is if it outlasts Essent, and it would seem that that might be the case. Some in corporate are wondering if it will last a year.

Ever Wonder??....12/13

Do we wonder about the Essent Board of Directors? Who they are, what other companies they're involved with? It does become interesting. I was perusing the Business Week description of the Essent corporate structure (which is way out of date) and found the board members.

David Mayer -Jazz Pharmaceuticals
Ron Wolford -ForHealth Technologies
James Elrod Jr. -Vestar Capital
Bryan Cressey -Thoma Cressey
Steven Silver -GoldToeMoretz
Jeff Goldsmith -Cerner
Bryan Marsal -GoldToeMoretz

One tidbit noticed about Cerner--The CEO and the Board vice-Chairman have sold a net of 55,000 shares within the last three months. How much confidence do they have?

As for Essent--Connery has decided not to pursue the lawsuit against Essent for an early release of the money for his shares.

Who's Resumes are in Play?....12/9

You have to wonder...since Essent was Hud's baby, how many executives with the company had personal commitments from Hud, promises if you will, that were keeping them in place? Is Essent due for an outflow of 'talent'?

While Essent is shopping for a new CEO, they might peruse the other aisles as well.

Buying companies is like buying stocks: Some people buy on momentum, some buy when they figure a stock is at its lowest point. There was consideration a while back--when Essent was in its game. Now, however: How low can you go???

Pakistan Repercussions?....12/17

With all the turmoil in Pakistan, the question becomes: How will this affect local healthcare if the political climate changes for the worse? We have several Pakistani physicians in our community, prime example is Doctor Hashmi.

The New England Journal of Medicine indicates: "Pakistan has contributed approximately 10,000 international medical graduates (IMGs) to the United States...." Only 300 have returned to the medically underserved country. Should there be changes in the relationship between the US and Pakistan, how will that affect those physicians currently in the country on resident alien or dual citizenship status? With those with a large portion of their wealth, or the majority of their family in Pakistan.

The new heart hospital, comes to mind. Speculation is all anyone can do without the facts, but that's probably what Essent is having to do as well. Assurances can only be based on the current situation, rather than a future one.

I would imagine that there will be no great changes, but one can never tell....

Awfully Quiet in Nashville....12/4

I figure that they're actually beginning to realize what Hud saddled them with. One scenario:

He bought hospitals that no one else wanted, but looked good on paper, tried to run "the big con" ala the Sting, and with him gone, things will probably fall apart.

He could sell the idea that the hospitals weren't profitable while they were being renovated. That renovation would take years. And years to start. Meanwhile, he could acquire some actually good properties (Muskogee comes to mind, as well as Weatherford) and borrow against the idea that his corporation owned five hospitals that they were willing to put money into. Sort of how they got Paris.

Or:

He actually believed that he could package a working system that would make the 15-20% return that he forecasted from bankrupt hospitals.

Your choice.

Essent should keep community informed....12/7

This is the first time I've seen the Paris News take a chunk out of the hospital:

Staff reports
The Paris News

Published November 26, 2007

Officials at Essent Healthcare, the parent company of Paris Regional Medical Center, need to keep this community informed of events such as a change in leadership at the top as happened earlier this month in Nashville, Tenn.

The Paris News became aware through a third party, and almost a week later, the companys founder, Hud Connery, had been forced to step down as chief executive officer by the companys board of directors and that Mike Browder had been named acting chief executive officer.

Essent public relations specialist David Jarrard did respond to a request for information for a Nov. 19 story, but an e-mail communications problem prevented us from receiving a response in time for that days edition.

Jarrards response was brief, stating the board of directors has a commenced a search for a permanent chief executive officer. He also said in the written statement that Browder joined Essent in 2001 as chief financial officer and that he served in a similar post for TMC HealthCare. From 1993 to 1999, Browder served as vice president of finance operations for Health Management Associates, Inc., where he was responsible for financial operations at 32 hospitals.

We should have received that information as soon as an event of this magnitude took place, not a week later and only at our request.

Members of our community should be kept abreast of what is going on with Essent. Paris Regional Medical Center is one of this communitys largest employers and serves the medical needs of the majority of our residents. In the past this newspaper has been supportive of our local hospital, but being left out in the cold about major events does little to help a relationship. After all, it is the responsibility of this newspaper to keep residents informed. A change in Essent leadership certainly warranted an immediate notification.

Actually, Hud's change in status happened in October. I posted the news on the 9th of November.

What If....12/8

Dux has been more than willing to say that he wants to get rid of those elements that Bitch, Piss and Moan at the hospital, but let's look at that....

His definition of bitching, pissing and moaning might be a bit different than ours. For one thing, those that are recognizing problems, and suggesting solutions are the ones that aren't saying, "That's not my job." Maybe administration would prefer that they were, but patients don't.

Housekeeping used a wax that was softened by the cleaning solution they used to mop it. It produced a sensation of sticking to fly-paper as you walked. Solution: Change the wax, or change the cleaner. The extra money spent would be paid back in public perception almost immediately.

An effective suggestion program can make the difference between red and black ink, but the opinion is anyone that doesn't believe that the moon is made of green cheese (admin's view), is a troublemaker.

Toyota is often cited as having one of the best suggestion programs of any corporation. They also had not laid off any employees since 1950 (not sure if that still holds true, but probably so.)

When you feel that your ideas do not fall on deaf ears, you are far more likely to feel appreciated for your efforts. As admin has found, complaints that you hear are backed 10 to 1 with those you don't. This blog could be a demonstration of that.

Complaints are opportunities (ironically, the link is about Vandy.) And the first part of a problem-solving process is to identify the problem. Those that don't appreciate that fact are doomed to failure.

Say the hospital did get rid of all those who have read or commented to the blog. Can you say, Ghost Town?