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From Proposals to Sources

Recently this space discussed the salient points of Adventist Health's proposal to affiliate with Mendocino Coast District Hospital (MCDH). A second hospital group, American Advanced Management Group (AAMG), sent in their proposal as well.

AAMG runs or manages six hospitals in California compared to twenty-one for Adventist Health (AH) throughout the western states. AAMG runs some clinics and senior nursing facilities, but readers may want to look back to the July 3 AVA to take note of the official troubles encountered by one of these facilities this spring.

Curiously, AAMG refused to be forthcoming about restrictions Medicare placed on a sizable SNF they operate in the Modesto area. MCDH posed this question in their Request for Proposal (RFP), “Describe any prior or current/pending state or federal legal actions/inquiries involving your organization, your management, or Board of Directors.

AAMG's response, “Unfortunately, we are unable to discuss any pending legal actions due to the need for confidentiality and to protect the rights of both our company and any other participants.”

Not a very forthcoming response given that the Medicare issues in question at the Modesto SNF had already been reported publicly in the Modesto Bee. AAMG cites over 30 years of hospital experience among their leadership team, which is composed of five individuals. One page of Adventist Health's organizational chart displays hundreds, if not thousands of years of experience. I can think of at least one member of Adventist's governing board in Ukiah who, alone, has close to 30 years experience in the medical sphere.

When asked to describe their commitment to put cash on the table, AAMG responded, “While it would be difficult to represent this type of commitment without a closer examination of the financial circumstances MCDH currently faces, AAMG typically would take responsibility for the costs of continued operations offset by the hospital’s collectibles. Additionally, we anticipate a budget of between $6-$10million for the facility’s repairs and renovations over the first two years.”

AAMG did not comment specifically on MCDH's potential need to meet seismic retrofit standards within ten years, however its proposal does state they will assume MCDH's current debt. AAMG's position on governance at the coast hospital: “Upon purchase of the facility AAMG would assume total control and responsibility for the hospital and its associated entities, at which point we would move forward as partners with the district in promoting healthcare issues and projects with the District if it sponsors such activities independent of the operation of the hospital. At this point we would name members to the hospital’s governing board based on our assessment of the facility, community and our business interests related to both. The new governing body would include people from the community as has been our practice in all of our hospitals.”

AAMG acknowledged that it prefers to keep present staff in place, relying heavily on their familiarity with the facility. Asked to address any changes to employee benefits, Adventist guaranteed all benefits and salaries for at least 90 days. AAMG's reply, “This question is difficult to respond to without knowing what the existing benefit packages are, their cost (employer contribution) and the availability of outside services in the area. In Glenn Medical Center and Sonoma Specialty Hospital [other medical facilities AAMG has recently acquired] the benefit plans have been preserved to date. The current options include three health plans with three tiers each. Dental, Vision and Life Insurance and a Health Savings Account”

While Adventist remained coy about OB services in its proposal, AAMG's proposal claimed it would upgrade OB services, including a potential OB clinic “if the need justified it.” “Potential” and “if the need justified it” are both diminishing qualifiers that ought to be read with a fair amount of skepticism.

This takes us to the labor and delivery department or, if you will, the obstetrics (OB) department. It is likely that changes are coming soon. It is likely that those changes will include somewhat outside the box solutions as well. That is all I feel is appropriate to write on this particular subject at this particular time without jumping the gun beyond the obvious data that numbers of babies birthed at MCDH annually has dropped below 100. At the same time the OB department has lost $1 million or more per annum for several years running. Draw your own conclusions, but be ready for a positive surprise.

This leads us to questions I've received recently, along the lines of how did you know that before almost anyone else? The obvious answer is sourcing.

Long time readers have most likely made the presumption that this writer has many sources connected to the medical profession, both within the immediate sphere of MCDH and spinning outward from it. It is correct to assume that those sources vary from close personal relationships all the way to grudging acquaintances. One thing that remains constant in writing about a specific subject matter for a number of years is the sanctity of sources' identities, no matter if I agree or disagree with their opinions or actions concerning MCDH.

Those close to the inner workings at the coast hospital may have guessed who some sources are. On at least one occasion a source “outed” themselves by writing in a local publication. A select number of sources may know the identity of someone else who provides information that ends up in the pages of the AVA, but generally I don't reveal one source's identity to another. Sometimes sourcing is simply a matter of listening or observing carefully and a person may not have known they gave up relatively important information.

When certain subjects get too “hot” even the most reliable of sources may clam up for awhile. One has to always have skeptical antenna up and wonder what motivated this “source” to tell me a certain thing. What do they have to gain? Are they playing me?

Defining where conflicts of interest may lurk for the writer presents an odd conundrum. The most obvious potential conflicts rest closest to home, in one's personal life and closest relationships, though, just as obviously, those are the individuals I rely on and trust the most, but I can't even come close to unduly favoring them when they've taken that leap into the public eye. Unless, of course, they are quantifiably right on a subject.

Whether removed from this writer's personal life or integral to it, anonymous sources provide information to the reading public that would otherwise be unavailable. Readers can judge for themselves where the author's prejudices fall. Regardless of personal relationships, I have, and will, base all opinions about MCDH on as many known and verifiable facts as possible.

Which takes us back to the OB department at MCDH. There exists sourcing that more than implies big changes coming, negative and positive. However, for the time being there's something fishy in the air, so the fish will remain beneath the surface. Somebody else can scoop them up.

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