Three Rivers Hospital CEO Bud Hufnagel. Photo by Ann McCreary

Three Rivers Hospital CEO Bud Hufnagel. Photo by Ann McCreary

By Ann McCreary

In an emotionally charged meeting, during which some Three Rivers Hospital medical staff members expressed lack of confidence in the organization’s leadership, hospital commissioners approved a plan that will cut staff and reduce or eliminate some services next year.

Three Rivers Hospital will continue to deliver babies for the time being under the plan adopted Monday (Dec. 16) by commissioners, who approved a motion designating obstetrics as a “cornerstone” of the hospital. Commissioners said they could not guarantee continuation of any particular services, and would review the hospital’s financial situation in six months.

A room filled with hospital staff and citizens heard Dr. James Lamberton, an orthopedic surgeon and longtime member of the hospital staff, criticize the current hospital administration for “lack of constructive leadership guiding the hospital through troublesome times.”

Three Rivers Hospital, located in Brewster, serves a district that stretches from Mazama to Mansfield. It has been struggling financially for more than a decade, relying on loans from Okanogan County to support its operations.

Two years ago the hospital board hired Mazama resident Bud Hufnagel, who has a background in health care consulting, as chief executive officer and gave him the job of trying to turn the hospital’s financial situation around.

Lamberton presented commissioners a letter, signed by seven doctors affiliated with the hospital, calling for Hufnagel’s resignation.

“There is a lack of trust due to lack of leadership and positive direction for our hospital staff, resulting in demoralization of the staff and bad PR in the community, “ the letter stated. “It is our observation that administration manages our hospital staff with negativity and fear.”

Lamberton said he has been affiliated with the hospital since 1979, first as a family physician and then as a surgeon. He blamed uncertainty about the hospital’s future, and particularly discussions about possibly ending labor and delivery services, for the loss of physicians affiliated with the hospital.

“We feel the administration is directly responsible for the loss of staff due to lack of leadership [and] due to the lack of commitment from the administration to continue obstetrics,” Lamberton said.

When hospital commission chairman Dan Webster asked Lamberton to end his presentation after several minutes, Lamberton refused. “We have a group of people who need to hear this and I plan to finish what I’ve started,” he said, drawing applause from the hospital employees and community members at the meeting.


Selection of scenarios

At the commission’s direction, Hufnagel developed several scenarios for restructuring the hospital and cutting services to try to make the facility solvent. The hospital commission’s last meeting on Nov. 25 was also filled with staff and citizens, many of them drawn to the meeting because of concern about possible elimination of obstetrics outlined in some of the proposals.

Three Rivers Hospital is one of only a handful of hospitals in the state that has achieved certification as a “Baby Friendly” hospital through an international program that promotes maternal/infant bonding.

Hufnagel narrowed the options for commission consideration this week to two, neither of which proposed eliminating labor and delivery services, which Hufnagel has termed a “loss leader.”

“We have never, never made a recommendation about what should or should not be continued in this entire discussion,” Hufnagel said in response to comments at the hospital board meeting.

“We were chartered to review what was making money and come up with a scenario of what would keep the most services and try to make money. People hear what they want to hear,” he said.

The financial strategy adopted by the board projects ending 2014 in the black with $422,349 in revenues. It calls for selling the hospital-owned HealthBeat Fitness program and a medical supply department, reducing hours in the hospital respiratory therapy unit, and ending cardiopulmonary rehabilitation services.

However, the board decided to defer action on closing the cardiopulmonary rehabilitation program until after January, when a new federal regulation goes into effect that requires a doctor trained in cardiology to be on site.

That requirement would have a significant financial impact on the hospital, which is exploring the possibility of collaborating with Confluence Health in Wenatchee to provide cardiopulmonary rehabilitation services.

The plan approved by the board would reduce full-time equivalent staff positions from 103.95 positions originally budgeted for 2014 to 85.79 FTE positions. Staff reductions would impact more than a dozen hospital services ranging from surgery to administration.

Lamberton said the staff was upset by previous administration statements “that there would be a 20 percent cut in staff by the beginning of the year … before there was any board action to reduce services.”

Many of those staff reductions have already taken place due to attrition, resignations or retirement, Hufnagel said.

“There are going to be some reductions in staff,” said commissioner Mike Pruett of Winthrop, who was recently elected to the board. “We are making some hard decisions.”

The plan also calls for downgrading the hospital’s emergency room from a Level 4 trauma facility, which means a surgeon is on-call within 30 minutes at all times, to a Level 5 facility without an on-call surgeon.

The hospital’s surgical suite would be open Monday through Friday, with no after-hours procedures other than emergency C-sections.


Fundamental role

In response to questions from staff about whether Three Rivers Hospital needs to provide after-hours emergency surgical services, Hufnagel responded, “the fundamental thing we do as a Critical Access Hospital is stabilize and ship” emergency patients to other facilities.

The commission authorized Hufnagel to move forward on creating an after-hours urgent care clinic at the hospital, which Hufnagel said he hopes to open in February.

In an interview Tuesday (Dec. 17) Hufnagel said he knows of only two people who will be laid off as a result of staffing cuts. He said the hospital is working with a Brewster resident on the purchase of the HealthBeat Fitness and medical equipment supply service, which he called “the best scenario because it gives the ability to keep it in the community.”

Hufnagel said he has worked on 15 or 20 hospital “turnarounds” in his consulting career. Three of them, including Three Rivers Hospital, have been rural hospitals.

“Those are immensely more difficult. You’ve got a limited resource pool and you have something that communities are emotionally invested in. Nobody disagrees with having all these services … but when you don’t have the resources to pay for them, that’s when the board has to make a decision,” Hufnagel said.

“What you saw yesterday [at the commission meeting] was a whole lot of emotion that was not confused with facts,” Hufnagel said. “They can get all cranky with me, and that’s OK, because I’m delivering the message.”