By Seth Rowe – Monticello Times
An issue of which doctors oversee patients at New River Medical Center arose again at a July 12 district hospital board meeting.
The controversy dates back to a decision by the Monticello Clinic earlier this year to end its participation in the hospitalist program, which provides doctors in the hospital to care for patients who are not assigned to a clinic’s doctor. After Monticello Clinic backed out of the arrangement, citing disagreements with the hospital’s administration, New River Medical Center began using Wapiti Medical Group personnel for the hospitalist role.
In May, the full medical staff proposed a rule change that would have assigned emergency care patients to a rotating roster of active staff physicians if they did not have a primary care physician who works on the medical staff. The Monticello-Big Lake Community Hospital District board voted to deny the request, with only former board member Joe Mahoney voting against the denial.
At the July 12 meeting, the board ended up voting down a reworked proposal that would divide unassigned patients among the Monticello Clinic, the New River Physicians Clinic and the Big Lake Clinic.
Dr. John Hering, vice chief of the medical staff at New River Medical Center and a physician with Monticello Clinic, said staff took feedback from the board into consideration when developing a reworked proposal. He said the new idea involving the three clinics was based on the concept of fairness. Doctors with the clinics could still hand over care to the hospitalist, if desired. The rotation could vary by day or on some other basis worked out by staff with the three clinics, Hering said.
Chief Medical Officer Mark Dietz said he wanted to continue to use the hospitalist program when assigning patients. Doctors with the hospitalist program are at New River Medical Center 24 hours a day, seven days a week, 365 days a year, Dietz said.
“A hospitalist program is a cohesive group and improves communication with the nursing staff and facilitates smooth communications with patients,” Dietz said. “I feel very strongly that the hospitalist program is the best way to deliver care to the patients.”
Board members responded that they preferred to deal with all the rules and regulations together instead of in a “piecemeal” fashion. Dietz said a consultant who works regularly with New River Medical Center could assist the board in reviewing overall rules.
But Hering replied, “Rules and bylaws are medical staff documents and they are to be evaluated and managed by the hospital staff, not the hospital administration. This is the first I’ve heard about anyone coming in to help with this. Those have to be reviewed and fully approved by the medical staff before they come here to the board for final approval.”
Hering added the medical staff feels it’s appropriate to fix an outdated regulation relating to the assignment of patients soon.
Board member Linda Doerr said, “I don’t think it’s a hardship to wait a few more weeks when we’ve waited so long. And it’s such an important item.” She added, “Mark (Dietz) has presented to us we have the best possible care for those people with the hospitalist program, so there’s nothing we’re lacking right now.”
Additionally, Doerr said she did not know if the hospital would be able to pay for the plan Hering proposed.
Hering argued the decision to manage patient assignments should be the purview of the medical staff. “This comes down to the medical staff and what they feel is appropriate,” Hering said.
Upon questioning by Chair Erv Danielowski, Hering acknowledged the medical staff vote in favor of the proposal was not unanimous. All but about eight staff members approved of the idea, though, Hering said.
Marshall Smith, chief executive officer of the hospital, said during a brief but heated exchange with Hering that the language of the rule only became a problem when Monticello Clinic chose not to continue to provide hospitalist services.
Hering replied, “It’s not a Monticello Clinic versus hospital issue. This is a medical staff rights and how they govern themselves issue.”
Ultimately, board member Richard Helms made the same motion he did in May, to deny the medical staff rules and regulations proposal. Helms asserted again the board needs to review rules and regulations as a whole.
Helms said, “You do it piecemeal, and you don’t know what you’re going to get.”
The board also learned that only one person has applied for the board member position Mahoney vacated when he resigned. Sheldon Johnson, a former Monticello School District superintendent, applied for the job. Board members expressed enthusiasm for Johnson’s candidacy.
“He’d be an excellent candidate,” Doerr said.
“Do we have to wait?” Danielowski asked. Danielowski made a motion to appoint Johnson, but board members decided to go with a suggestion Smith made to take up the appointment matter at a later meeting.
Voters will have an opportunity to elect hospital district board members this fall. Filings open for four elected hospital board seats Tuesday, July 31. The seats for members from Big Lake, Silver Creek Township, Monticello and an at-large position are up for election. The seats all have four-year terms that begin next January. Filing closes Tuesday, Aug. 14. There is no filing fee. The election will take place Tuesday, Nov. 6.