A Calaveras County Grand Jury report that outlines reasons for “lost confidence” in the county’s health care system hits mostly on ill “perception” rather than actual poor performance, according to a 13-page official response letter from the Mark Twain Health Care District released Wednesday.
The March 27 report criticized a lack of transparency in the operations of Mark Twain St. Joseph’s Hospital, which has been leased to the private not-for-profit Mark Twain St. Joseph Healthcare Corp. since 1990 and run by Dignity Health, formerly Catholic Healthcare West.
The response submitted by district board President Lin Reed said the case that the district’s hands are tied in many respects by the state’s Local Health Care District Law and the arrangements provided in the contract with Dignity Health already exceed public input requirements in the law.
Though the arrangement may not be ideal, Reed wrote that “what the Grand Jury failed to emphasize in the Grand Jury Report is that stand-alone, District hospitals are not financially viable, particularly in rural areas. It is only by entering into the lease arrangement that the Hospital’s operations remain viable. It is not at all clear that a hospital could be maintained in Calaveras County were the lease arrangement (through 2019) to be discarded.”
The contract provides for two district board members to sit on the hospital’s private corporate board as well as a district appointee, the letter stated.
“The State law … does not require that the private corporation provide any representation at all to the health care district on its private board or access by the public to its meetings,” Reed wrote. Board term limits are not permitted by law, the response stated, answering criticism about little turnover in its composition.
The letter does agree that the district should have better handled some of the events that may have created a crisis of confidence.
“In August 2010 when the District’s State designation was changed from that of an ‘acute care hospital’ to that of a ‘critical access hospital’ the manner in which ... the District made the information available to the public, was less than completely satisfactory,” Reed wrote.
The move was made to increase Medicare reimbursement and entailed cutting the number of available hospital beds nearly in half from 48 to 25.
The letter also admits a similar failure to “adequately report the matter to the public” when about 10 physicians left in a short period of time, many citing conflicts with management that has since been replaced.
“The District agrees … that the perceived exodus of physicians from the Hospital has left a perception that they must be leaving for a reason, and that this could in turn lead to a loss of confidence in the ability of the Hospital to deliver quality health care. The District and the Corporation have cooperated in the last six months, beginning well prior to the receipt of the Grand Jury Report, to address this perception,” Reed wrote.
The district’s response denies the district could have been more forthcoming about the subsequent changes in top management, as CEO Feliciano Jiron resigned.
“The CEO is an employee of Dignity Health, not the District, and therefore any changes are of necessity kept as a confidential personnel matter until after they have occurred,” the response stated.
Jiron’s interim replacement, Patti Monczewski, was “well received by the medical staff,” Reed wrote.
“Additionally, the Corporation Board has changed its leadership, appointing a new (chairman) who is himself a physician,” the letter stated. “Indeed, four of the current members of the Corporation Board are now doctors, indicating the Corporation itself clearly recognizes the need to have better relations with its medical staff.”
Dignity Health hired new permanent CEO Craig Marks in May.
The response denies the corporation holding its records constitutes control of access to those records but agrees “the arrangement is confusing to the public and that alternate arrangements should be made despite the potential for increased cost to the public.”
Reed wrote that the district will seek a guarantee in the corporation’s bylaws to maintain its representation on the corporate board, per the Grand Jury’s recommendation, but notes that “there is no forcing function to compel the private Corporation to concur.”
The letter disagrees with the Grand Jury finding that a Management’s Discussion and Analysis was illegally excluded from an annual audit, stating there is no legal requirement to include that document, but the district “will require MD&A for future audits even though doing so is optional, beginning with the next annual audit.”
Contrary to any perceived loss of quality of care, Reed’s letter notes that the hospital has performed well above average for the state in patient surveys and prevention of hospital-acquired infections and recently renewed its national accreditation.
The response said the district will voluntarily submit to the recommendation of providing annual reports on the state of the county’s health care to the Board of Supervisors.
It is addressing a complaint about minimal public notice of board meetings by posting them in the 24-hour emergency room and county library and considering a notice on the hospital’s electronic reader board but hedges on whether or not the district will launch a website, where it would also have to post them.