Last Wednesday (January 26), a group of local concerned citizens presented the results of an independent external audit of the hospital operations to the Mendocino Coast District Hospital Board of Directors and CEO Bryan Ballard. The community has been asking for such an audit for a year but the Board and CEO have stonewalled, choosing to pay $25k for their own self-audit which was completed a few weeks ago.
A group of four local professionals and concerned citizens funded the audit out of their own pockets, probably in the five-figure range (based on my estimate of the non-independent "Delta One" audit presented by Ballard at a cost to our hospital of $25,000). These local citizens have listened to the community and decided to hire professional consultants from Rural Health Management in Nephi, Utah — an organization with a world-wide reputation for excellence in the management of rural healthcare — to audit the hospital's management and finances.
CEO Ballard and the Board immediately went into public relations damage control mode before the group of local concerned citizens had a chance to present their recommendations. Ballard had whipped up a two-page "rebuttal" to the audit report/presentation which he called a "preliminary rebuttal," promising there would be more to come.
Ballard opened the meeting by giving an impromptu explanation, which was not on the agenda, rambling on for at least 15 minutes "rebutting" and attempting to discredit the recommendations of the independent audit which no one had even seen yet. It's probably not a Brown Act violation, but it is another Brown Bag Act. Already, Ballard's smear campaign to discredit the independent audit has begun. It reminds me of Washington DC.
Mr. Ballard is pretty arrogant. And his Board of Bobbleheads just goes along with him — just like last year. They have a "bunker mentality," not an open mind in the bunch. They were totally on the defensive, with zero creativity or new ideas. The attitude is to blame the community for being smart enough not to pass Proposition R, the $99 per parcel bond measure that didn't get close to the necessary two thirds vote last year.
Local citizens continue to try to give input to management hoping for an opportunity to be heard. But Ballard and his Board were all in "rebuttal" mode.
After the presentation by the audit team one of Ballard's trustees (Jim Hay) said he was very upset that the findings of the independent audit were given to the community before the Board had seen them. It was then pointed out that the chairperson of the board, Ms. Charlene McAllister, did have the findings in her e-mail a week before the findings were disseminated to the community. Hay was very upset and in strong words requested that this presentation of the recommendations should not be given to the community or media.
Note: The Fort Bragg Advocate reporter was present at her own personal little media desk provided for her by the Board and CEO. Are they attempting to influence the way these independent audit findings are reported, findings over which they have no editing control? (Ballard and Co. had the luxury of "editing" the previous $25k report.) Is this a violation of the Brown Act? Or yet another brown bag job? Or is it just another attempt to "censor" information that the community paid for and to which they should have direct access?
Page 8 of the audit findings reports under "team observations" of the financials of the hospital, "Unless those processes [the hospital's financial accounting methods] support efforts to drill down sufficiently to fully understand the anatomy of the outcome, the chances of the loss repeating itself are greatly increased." I.e., unless they do something different they'll continue to lose over a million dollars a year.
But taking this medical metaphor to its logical conclusion, maybe they mean that the anatomy of the outcome is a prerequisite for the autopsy of the outcome. We still do not know what kind of out-of-control beast these hospital finances have become and the patient may die before anyone knows what it is or how bad it is.
The community feels that the board and the "local press" (i.e., the Advocate/Beacon) are all under novacaine, anesthesia, paralysis, or hypnotic suggestion administered by Mr. Ballard who is responsible for the hospital's losing millions of dollars in the years since he was hired at his kingly salary.
From talking to the community, it is very clear that 100% of our community loves this hospital. The Hospital is not the issue. We want it fixed. We do not need "rebuttals" to this independent audit, especially from the totally discredited board and the CEO who have presided over the loss of over $1.1 million per year over six years. This translates to $1064 for every man, woman, and child in Fort Bragg! ($1.1 million x 6 years = $6.6 million divided by the population of Fort Bragg).
The gross mismanagement over this period makes me wonder why the Board didn't simply fire Ballard long ago. Is the Board governing the hospital, or is the Ballard governing the Board — as he governs the coastal media — with his "smoothness" (as reported in the independent audit)?
The feeling in the community is that the Board and Ballard are trying to punish the community for not passing their bail-out, er, parcel tax. They are cutting needed operational services to show (punish) the community they need more money, coercing the residents to support another parcel tax. I do not know where this feeling comes from, but maybe it is the arrogance of the Board and Ballard, or it could be mismanagement, or maybe it is just that the Board and Ballard are in over their heads.
Example: They have seriously proposed cutting the ambulance service, saying that it is not profitable!
I ask for the 16th time to clean up the internal timecard accounting mess. You see, the EMT's have 97% "idle time." During this "idle time" the EMT's are doing tasks inside the hospital that nurses should be doing. The EMT's could/should charge time to the hospital when they are performing Emergency Room tasks and charge the time to the ambulance when they are working with the ambulance. This still is not fixed. This alone may well save the ambulance, but the Board and Ballard are not taking action on it. The audit shows that the accounting of the EMTs is a mess at best. By not fixing this accounting mess they may think they're adding to their threat to cut the ambulance, putting more pressure on the community to pass another parcel tax.
To add insult to injury, and further showing their arrogance, Ballard reported that the only hospital department that is "profitable" this month is the Emergency Room! No surprise! The ER is 97% subsidized by ambulance paramedics and EMTs whose time the hospital does not account for. I have personally experienced this. The issue has been brought up to the Board/Ballard by me many times, as well as by nurses and EMTs themselves — but nothing has been done. WHY NOT? One is forced to conclude that they are punishing the community by threatening to terminate the ambulance to get a parcel tax passed.
The independent audit found that Ballard and his Board act with a homogenous mentality with zero diversity in their thinking. All of them, when interviewed individually by the auditors, said, in effect, "The fact that the hospital is failing is the community's fault."
The auditors recommend that at least two board members — "it really does not matter which two" — be replaced. The community says YES — we need "fresh blood."
The community needs to know why Ballard wasn't fired fours years ago. Ballard is still here, being paid well over six-figures plus his annual salary increases, bringing his total compensation to well over $150k/year (plus undisclosed perks). This does not help to engender trust in the community. The independent audit disclosed that "salary increases at the Hospital were 9% in 2005? We, as well as the auditors, are confused. The nurses and doctors took a hit of 20% decrease and/or a salary freeze — some of them are still frozen. So who got the increases that produced an overall 9+% increase in hospital salaries?
In conclusion, based on their own numbers, Ballard and his Board have mismanaged this hospital for too long. We do not need any more self-serving rebuttals and windy explanations from Ballard and his Board. Their dismal performance speaks for itself.
If they support this hospital they should all resign, turn in their credit cards and expense accounts, and let the community start rebuilding this hospital to something like the condition before Ballard & Co. took over. It is time for them to go.
We acknowledge the Board's long hours of work and dedication with no pay. In my heart, I believe the Board means well. But in the end, they have failed this community.
These legitimate hospital management experts have reported, "The hospital board is not doing their job! Management must be held accountable. (I know these are strong statements.) The board needs to be educated in order to do their job correctly — or be replaced. Such drastic board changes will take time and must be started soon in order to save the hospital. I still think you can turn the hospital around however, it will take some real effort. Time is short. If another year passes without change, I'm not sure you will be able to save the hospital.
The Hospital Resource Council which commissioned the independent audit will make a formal presentation of their recommendations on Thursday, February 9 at Fort Bragg's Town Hall. (Or possibly at the Hospital Conference Room, the location is still being disputed. Call the Hospital to confirm.) Anyone who cares about the future of our hospital should be there and show their support for an honest appraisal and forthright approaches to the hospital's many financial problems.