Contracts, consultants, and hotel bills

Note concerning documents: some of the documents I am posting pertaining to Washington County Regional Medical Center and the Washington County Board of Commissioners have notes and underlined portions. I have not marked up any of the documents, they are uploaded exactly as I received them. All documents here and in a February 15, 2015 post on Rural and Progressive were obtained through Georgia Open Records Act requests.

Sometimes the best way to solve a problem is to have a fresh pair of eyes look things over. In September 2014 the Washington County Board of Commissioners (WCBOC)  received a contract from consultant Alan Richman, the President and CEO  at InnoVative Capital(IC).  Richman offered to assess and advise on several areas of hospital operations.

On October 9, 2014, Board of Commissioner Chair Horace Daniel signed the contract (InnoVative_Capital_contract_Sept_2014) . The contract detailed seven tasks for Richman to complete:

  • Hospital Financial and Operational Review
  • Staffing Study Review
  • Review of Outstanding WCRMC Funding Requests of Washington County
  • Review and Critique Management and Consulting Proposals Received by WCRMC
  • Identification of Issues Statement
  • Produce a Strategic Roadmap of Next Steps
  • Present Finding to Washington County

The contract included the possibility of an extension through December 2015. Washington County agreed to pay a “hospital consulting fee” totaling $40,000. A non-refundable payment of $20,000 was due when the contract was signed, and the remaining $20,000 would be paid when Richman presented his findings to the county.

My Open Records Act document search included an email to former County Manager Chris Hutchings in late March 2015 from Richman detailing his suggestion that additional consultants may be required for his project here. These consultants would be “retained” by Washington County. Richman credited the county’s earlier $20,000 payment to his new contract proposal and requested an additional $10,000. On April 13, 2015 Horace Daniel signed a new agreement on the county’s behalf that included a monthly payment to IC for $7,000 plus expenses. (InnoVative_Capital_contract_April_2015)

What is especially interesting about the April 2015 contract is item 14 on page 2: “If the Transaction involves the WCRMC’s Partner’s commitment to a replacement hospital or major renovation/project (“Hospital Modernization Project”), InnoVative Capital may provide mortgage banking services for this purpose under a separate contract with the WCRMC Partner, if asked to do so by the WCRMC Partner, the Hospital Authority, or the County.”

The county’s hospital consult also does mortgage banking services.

And bonds.

Think about that for a minute.

If the county’s consultant recommends a new hospital building or major improvements, he can then step up and offer financing services. If bonds are needed, Richman’s consulting company does those too.

And there’s more.

On pages 3-4, (InnoVative_Capital_contract_April_2015) the contract spells out what Richman’s company receives in different scenarios. for example:

  • The county requires debt funding of $7-10Million, signs an “External Management Contract” or extends the Management Agreement with University, or “retention of Replacement Internal Management”

If University Hospital is the signing partner InnoVative Capital would be paid a $40,000 transaction fee.

If a partner other than University was the Partner for an External Management Contract, Richman’s company would receive an  $80,000 fee.

  • WCRMC enters into a Lease or Change of Ownership  and the county has a net debt funding requirement of less than $5Million:

If University is the Partner, InnoVative Capital receives $100,00 plus 5% times the final Net Debt Funding required < than $5M

If a Partner other than University is engaged, IC makes more money. Richman’s company would be paid $140,000 plus 5% times the final Net Debt Funding required < than $5M

Any agreement or modernization project that didn’t include University Hospital meant a bigger check from Washington County for Richman’s work.

Richman made seven trips to Washington County that cost taxpayers $14,483.45. Some of Richman’s expense reimbursements are a simple word document with no receipts attached. However, the request submitted on  June 29, 2015 reveals that Richman’s hotel of choice isn’t anywhere near Sandersville. The county’s consultant stays at the Ritz Carlton in Atlanta’s toney Buckhead district near the Governor’s Mansion, and commutes to Sandersville in a rental car. (see page 10 InnoVative_Captial_invoices)

Richman submitted another contract for his services in November of last year, one that would run from November through July 2016. Richman’s monthly consulting fee jumped from $7,000 per month to $10,000 per month, an increase of almost 43 percent. Horace Daniel committed the county to the higher monthly consulting fee when  he signed the contract on November 13, 2015. (InnoVative_Capital_contract_November_2015)

The November 2015 contract includes a list of 12 items for Richman to work through. Item 8 reads, “Identify potential partners for the County and Authority and work to make the process competitive, if possible.”

If possible.

Hospital leaders here did a call for proposals for management/lease options in the fall of 2014 from nine companies/organizations. University, Navicent Health, and Augusta University were among the nine asked to submit proposals. The resulting document includes a response from University but nothing from Navicent. Augusta University (Georgia Regents Health system at the time, still often called the Medical College of Georgia) was interested in a partnership but “without any change in management,” i.e. they didn’t want to run our hospital.
( see the last page in WCRMC_requests_for_proposals_fall_2014)

We had a plum lease agreement from University Hospital last spring that was left on the table by county leaders (University_proposal_to_WCRMC_April_29_2015). Navicent Health never made an offer last summer, which prompted local officials to pursue a partnership with Augusta University Hospital (which had already said it didn’t want to manage WCRMC).

The contract Horace Daniel signed in November includes a scope of services for Richman to complete. The resulting recommendations for the county to consider are contained in no more than two pages in a January 21, 2016 document, titled Washington County Regional Medical Center-Plan B:Repurposing WCRMC-Business Plan Development is “for discussion purposes only.”

The proposed plan development team includes two consulting firms in addition to InnoVative Capital. Richman allows for eight weeks of work. Depending on the amount of work required, the fees for the market and financial feasibility consulting firm DHG Healthcare could range from $35,000-$45,000. Adams Management Services, a capital consulting company, would ring in at $12,500. Both companies would also bill for expenses in addition to their fees.

Who would manage this project?

If you guessed Richman proposed that his company should serve as the Project Manager you would be right.

Through January 2016 Washington County taxpayers have spent $102,000 on consulting FullSizeRenderfees to InnoVative Capital. Combine those fees with $14,483.45 in travel expenses, and we’ve spent $116,483.45.

The more time I spend reading these documents, the more I scratch my head.

Of course we need a hospital here, and it should be a good one. We are fortunate to have good doctors and hospital staff who want their friends and family to receive the best care possible, at home, when they need it.

I don’t expect the bond to fail in May, and I am not suggesting that people consider voting against it.

What we need to understand as voters and property owners, is that we didn’t get to this question overnight. We are more likely to hold our local leaders accountable for our hospital’s sustainability if we know the full story.

The documents behind a $15.4M question

Washington County Regional Medical Center (WCRMC) has steep financial challenges. That doesn’t make the rural hospital in Middle Georgia unique.

The solution proposed by recently appointed Hospital Authority members led by Chair Jim Croome, and, the Washington County Board of Commissioners (WCBOC), is to ask the county to approve a $ 15.4Million dollar bond.

The debt that citizens can choose to take on in a May referendum will fund $9M for infrastructure, IT, and computers at WCRMC. Property owners will have to decide if their personal budgets can stretch to take on more in property taxes to also give the hospital $6.4M to pay down debt, address pension plans, and general operations.

Last year the Washington County Tax Commissioner included a neon green insert with 2015 property tax bills stating that one mil of their taxes was being used for the hospital.

Last year county leaders could have chosen a course of action that might have made last week’s 2.5+ hours county commission meeting a lot shorter.

In late April 2015, county and hospital leaders had an option to improve operations and secure $5Million in capital improvements through an offer from University Hospital in Augusta. A management agreement already in effect between the two hospitals had already secured a $1Million line of credit for WCRMC.

University’s offer included a 20 year lease with an option for Washington County to sell the hospital if it decided that was the best course of action (University held first right of refusal. After that Washington County could pursue another buyer: page 3, University_proposal_to_WCRMC_April_29_2015). University guaranteed 24/7 Emergency Department operations, surgical and inpatient nursing services, and diagnostic and imaging services.

The lease proposal also stated that University, “will not seek any support from Washington County for the operation of WCRMC” during the first five years of the lease agreement (page 3, University Hospital offer to WCRMC April 2015).

University has already proven it can right-size a small hospital; just ask McDuffie County residents and patients at University McDuffie County Hospital.

Instead of saying “No thanks” to the offer, the Washington County Commissioners took a different tack, one that broke the management agreement with University and a retraction of their April offer.

County Attorney Tom_Rawlings hand-delivered letters on June 8th to local doctors inviting them to a private meeting with Navicent Health representatives from Macon to “structure a partnership with a larger hospital system.’ The meeting wasn’t planned for county offices or Rawlings’ office , both located on the high visibility Courthouse Square.

Instead, the June 8th meeting to discuss a possible relationship with Navicent was planned at Daniels Heating, Air, and Electrical just north of Sandersville, where cars travel pass at 55 MPH. The Chair of the Washington County Board of Commissioners is Horace Daniels.

While Navicent Health was planning a meeting with Washington County leaders and physicians, their 11 month old management arrangement with neighboring Oconee Regional Medical Center was spiraling towards a fatal crash.

The meeting Rawlings convened where the WCBOC Chair works violated the Management Agreement between University and WCRMC according to a letter dated June 12 from University’s CEO Jim Davis.

Davis closed his letter with, “We wish you and the Commissioners the best of luck in preserving a hospital in Washington County.”

Washington County leaders signed an agreement with University that secured a $1Million line of credit for our hospital. The organization that right-sized McDuffie County’s hospital proposed a 20 year lease agreement with $5Million of improvements to our struggling hospital. It did not include a request for $15.4Million in bond debt funded by Washington County property owners. It did include a restriction on future requests for taxpayer dollars.

Washington County needs a good hospital. Voters should have an opportunity to read the documents that brought us to a $15.4Million bond referendum in May. As I work through more documents I’ll post them here.

The needle hasn’t moved much since last year

This was originally posted last year on September 11. We continue to be a badly broken country in too many ways. No photo today.

How we have failed since September 11, 2001

Tonight President Obama will address the nation about ISIS and any actions that we may take in response to the horrific murders of Americans and innocent civilians at the hands of terrorists.

Tomorrow there will be an observance in my community, and many others, to honor the thousands of lives lost to hate and terrorism, and to support the families and friends who knew someone they loved would never return home again.

Since September 11, 2001 we as a country have talked a lot about being kinder to one another and being a better country. Yet 13 years later this is what consumes us as a country:

  • fighting about allowing two consenting adults of the same-sex to legally marry each
  • failing to take care of the thousands of veterans who have defended our country, many of whom returned with horrible wounds from the Middle East since September 2001
  • allowing private corporations to decided which forms of legal birth control they will cover for employees through company based health insurance because some corporations should have the same privileges as churches
  • granting corporations the same rights as citizens so businesses can pour money into elections and our representatives’ pockets
  • making it harder for citizens to exercise their right to vote
  • subsidizing corporations with huge tax breaks while their employees working full-time never earn enough to break the poverty barrier
  • denying the hard facts of science because profits should come before cleaning up the mess we’ve made of the entire planet
  • deporting children
  • complaining about failing schools while slashing teacher pay and testing our children to death
  • sitting by silently while racism and sexism are displayed proudly
  • being sure we can take our assault rifles into the grocery store
  • we pay for and support violence on playing fields, in the movies we watch, video games we buy, music we listen to, and television shows we watch, but we react with horror when students are sprayed with bullets in their classrooms, women are drug from elevators by their hair, students are bullied, children and women are raped as well as being forced into prostitution
  • too many among us are convinced that their brand of faith should be followed above all others, and if necessary the rights of other citizens should be denied because they choose to worship differently, or not at all

We absolutely should remember and honor the victims of September 11th’s violence. I’m just not convinced we are a country that is a better reflection of the democratic values and freedoms which terrorists intended to destroy 13 years ago.

Where’s The Friday Photo?

I didn’t post a photo last Friday because I didn’t think I had anything that was worth posting. What I did think about a good bit on Friday, and other days, was about putting Rural and Progressive on hiatus to figure out if I should continue.

It takes me A LOT of time to crank out posts that are heavy on politics. Fact-checking, reading a variety of sources, double checking, proofing, maybe asking for a review before posting, and triple checking take time. When I worked at home and my schedule was flexible I could pick up and put down posts throughout the day.

And then today Hillary announced. So I signed up and donated to her campaign.

This election isn’t about electing the first woman POTUS (even though we’re behind the curve on electing women to national leadership in America). This election is about children, women, seniors, people of color, my LGBTQ friends and family, the middle class, the working poor, our veterans, energy production, peace, public schools, rural communities, national infrastructure, the arts, health care, housing, food shortages, and our natural resources.

So I ‘m figuring out what Rural and Progressive will be in the future.

Got a suggestion? I’d love to hear it.

 

Gov Deal’s band-aid approach to health care

Hancock County, Georgia’s poorest among our 159 counties, is getting much needed help with access to health care via technology, community leaders, and innovators in delivering care to patients.

Right now people living in Hancock County have to drive to a neighboring county to see a doctor for any and all medical concerns. Even something as simple as an ear infection requires a drive of at least 25 miles to another county. Getting to the doctor can be a huge expense and feat of logistics for Georgia’s rural citizens, including those in Hancock County.

A new program, with a price tag of just $105,000, will now bring state of art health care to Hancock County’s citizens. Patients, Emergency Medical Technicians (EMT), and doctors,  connected through secure technology, will work to determine medical problems and where a patient needs to receive care. Emergency room trips and the cost of care should be reduced, while patient health outcomes, and the establishment of medical homes for patients, should improve.

I don’t want to diminish the importance of this program for Hancock County, which has Governor Deal’s support.

But it is important to understand that  making access to health care easier and more affordable for Hancock County’s citizens via technology, isn’t  enough to address the failure to provide affordable health care to all of Georgia’s citizens.

And a  pilot program announced by the Rural Health Stabilization Committee last week won’t either. The Committee  will create four hub and spoke type health care delivery sites. Dcotors and EMTs, along with the patient and technology, will assess medical problems and get the patient to the appropriate place for care.

Using technology to care for patients isn’t new in Georgia. Telehealth has effectively been used for emergencies, specialty consultations, and mental health care in our state for years. What these programs offer should increase access to very good health care, reduce costs, save time, and improve patient health outcomes.

But these programs aren’t going to solve the bigger problems of delivering health care to Georgians and making it affordable. The Rural Hospital Stabilization Committee wasn’t convened to address Medicaid Expansion. Gov Deal’s spokesman Brian Robinson has been clear about that.

Governor Deal remains a staunch opponent of saving our state millions of dollars with Medicaid Expansion and improving access to health care for underserved Georgians.  Instead, he and his buddies in the Georgia General Assembly, chose to constrict access to health care via Medicaid Expansion. That also means our elected officials have redirected the federal tax dollars Georgians send to Washington every year to states who have chosen to expand care and reduce costs with Medicaid Expansion.

Hancock County’s new telehealth program, coupled with the hub and spoke pilot program designed by the Rural Hospital Stabilization Committee, are big pluses for a few communities.

Governor Deal and the General Assembly can do more for Georgia’s citizens who need access to health care. We need more than a lick and a promise.

 

 

Declaring Victory

Goal Met

I had no idea what the response would be to launching a Go Fund Me campaign asking people to help me go to a camp for grown ups. The time was just too ripe for me to get to this camp led by Patti Digh, and so I decided to be my own advocate. I’ve asked people to sign comments  to support clean air and water, marriage equality, access to health care, and other issues, but IU’ve never done a “help me personally” type of ask.

This has been a humbling experience for many reasons. I’ve not told my story for myself, and for that purpose alone the experience is valuable. As a participant in other campaigns I have been amazed at people stepping up because there was value in the need and ask. I wasn’t sure that would happen for me, and every time it did I had to catch my breath.

I’ve got a lot to do between now and the time I leave for Life Is A Verb Camp 2014. Right now I am letting such unexpected generosity soak in. I am appreciative of the what everyone did to make this happen, from sharing the link to the campaign to actually typing in a donation amount.

Thank you.

 

Fracking for the Cure

pink drill bit

There’s just no saving the Susan G Komen organization from itself. For the second year in a row, Komen has lined up to get a $100,000 check from Baker Hughes, a fracking company. Baker Hughes is so committed to helping find a cure for breast cancer that it is shipping out 1,000 drill bits painted in a specially commissioned Komen Pink, packed in pink boxes with a fact sheet on breast cancer tucked inside, to rig sites.

The fact that Baker Hughes uses fracking chemicals that contain known cancer causing agents clearly isn’t worrisome enough for Komen to turn down a check.

Kudos to Susan G Komen and Baker Hughes for creating the most phallic breast cancer prevention campaign I’ve ever seen. I can barely wait until October 2015 to see how they top this one.

My first sleep over camp

Most readers of Rural and Progressive have followed the work I have been lucky enough to be part of to stop a proposed coal plant in my rural Georgia community. None of us knew what was ahead almost seven years ago when we came together to speak up for the health of our community except that it would require strong backs, patience, strong partnerships, and grit.

The ugly part of this work has been the tearing apart of decades-long friendships and splintering of families. Sometimes when people stand up for what they believe is right, no matter how difficult that may be, communities become divided.

Four years ago I made what was probably the hardest decision I have made since I heard the announcement for coal-fired Plant Washington: I stood my ground for my values and integrity when I was asked to sit on my hands. Given the choice of sitting in silence and keeping my job, or speaking up for what I believe in, I chose my values and beliefs.

I took on a job that, if we won, would put me out of a job. Fighting Plant Washington full-time required a commitment to a much smaller paycheck, and sometimes no paycheck at all. Environmental activists don’t get rich fighting the fossil fuel industry.

Plant Washington opponents won’t stop until the project is cancelled, but the writing on the wall is in all capital letters for this coal plant. That means it is time for me to figure out what I will do next.

The scars and experience I’ve accumulated can’t be boxed up and put away. The challenge now is finding a way to put them to work for a community or organization that needs an advocate/activist to help in their work.

Can I find a way to cobble together work that will pay my bills without requiring me to move away from my family? What could that work be? Where do I look and how do I do that with clarity and focus? Who might help me and how do I make the right ask?

At 53 years old, I am ready to go to a sleep over camp for the first time in my life-
a “camp for grown camp fireups.” Life is a Verb, a three day camp/workshop/retreat will challenge me to find the questions I need to ask, and begin to work towards the answers.

Patti Digh wrote this about the camp she is leading, “Camp is a place where people of all walks of life come together to explore what it means to be fully human and what it means to live life fully, as an active and not a passive, verb. To live, and live fully. To love, and love well. To let go, and let go deeply.”

As an advocate I’m not used to asking for myself, but I am trying to let go of that stumbling block now. I set up a Go Fund Me account because I simply am not able to cover the costs of going to camp and finding a sustainable way to what is next for me.

My goal is to cover the costs of camp and traveling back and forth. I’ll arrive there ready to do the work at hand and maximize every minute. What I learn will help me step into the unknown that is knocking on my door.

My life has truly been an action packed adventure since I stepped into a huge unknown almost seven years ago. Now I have skills and experience I want to share with people and communities who have challenges of their own. What I have learned is meant to benefit others, not be put on a shelf and collect dust.

I’ll write about my adventures at Rural and Progressive as I prepare to leave and when I return (letting go for me also includes less time with electronics).

I hope you’ll support my first-ever camp experience with a donation. Any amount will help send a 53 year old advocate/activist to camp for the first time.

How we have failed since September 11, 2001

Tonight President Obama will address the nation about ISIS and any actions that we may take in response to the horrific murders of Americans and innocent civilians at the hands of terrorists.

Tomorrow there will be an observance in my community, and many others, to honor the thousands of lives lost to hate and terrorism, and to support the families and friends who knew someone they loved would never return home again.

Since September 11, 2001 we as a country have talked a lot about being kinder to one another and being a better country. Yet 13 years later this is what consumes us as a country:

  • fighting about allowing two consenting adults of the same-sex to legally marry each
  • failing to take care of the thousands of veterans who have defended our country, many of whom returned with horrible wounds from the Middle East since September 2001
  • allowing private corporations to decided which forms of legal birth control they will cover for employees through company based health insurance because some corporations should have the same privileges as churches
  • granting corporations the same rights as citizens so businesses can pour money into elections and our representatives’ pockets
  • making it harder for citizens to exercise their right to vote
  • subsidizing corporations with huge tax breaks while their employees working full-time never earn enough to break the poverty barrier
  • denying the hard facts of science because profits should come before cleaning up the mess we’ve made of the entire planet
  • deporting children
  • complaining about failing schools while slashing teacher pay and testing our children to death
  • sitting by silently while racism and sexism are displayed proudly
  • being sure we can take our assault rifles into the grocery store
  • we pay for and support violence on playing fields, in the movies we watch, video games we buy, music we listen to, and television shows we watch, but we react with horror when students are sprayed with bullets in their classrooms, women are drug from elevators by their hair, students are bullied, children and women are raped as well as being forced into prostitution
  • too many among us are convinced that their brand of faith should be followed above all others, and if necessary the rights of other citizens should be denied because they choose to worship differently, or not at all

We absolutely should remember and honor the victims of September 11th’s violence. I’m just not convinced we are a country that is a better reflection of the democratic values and freedoms which terrorists intended to destroy 13 years ago.

 

A burning take on the Ice Bucket Challenge

This was posted on my friend, Derek Maingot, on his Facebook page on August 21. He kindly agreed to let me repost it here.

Michael Jack
Michael Jack

I’ve been asked by several hundred (slight exaggeration) people now why I’ve not done the ALS Ice Bucket Challenge. Two WEEKS ago Zhan was the first person I saw on the internet doing this, and he challenged me. 

This is long before it took off and I kind of feel proud to have been one of the first to get challenged.

He challenged me because my dear friend Michael was slowly beaten down by this disease. 13 long years of fights. 3 years ago, on August 22 he sent us an email that he’d prepared, saying that he finally succumbed to ALS. The subject of the email was “That’s all she wrote”.

So why have I not done this challenge? Yet?

Well, I’ll be honest, I’ve been having a BLAST watching this thing go viral. I originally promised Zhanny to try (TRY) and do something at Burning Man next week. Those of you know know me know that this disease is the one that I’ve always raised money for over the years and marched in Washington several times with Michaels Fund Raising Team the JackALS.

So I donated and I’ve sat back happily watching my nephews and friends’ kids talking about a disease that they previously knew nothing about. Awareness has gone through the ROOF and so have funds to help people living with the disease. Michael hugely benefitted from these funds from the ALS Association. It’s not all about ‘research’ and the idiot haters out there obviously know NOTHING about how non-profit organizations operate and how they help people with ALS. As that amazing kid said on his video, you’ll soon return to watching cats. For now this is a great spotlight.

Anyway, I’m just so FREAKING happy that this is all happening. We would fight to raise 30, 40, 50 thousand dollars at our walks in DC, and as of today, people have donated a thousand times that amount. I can only smile and know this is all good.

My challenge might be probably among the last to get done, even though I was one of the first to get challenged, but my heart swells to see how great this has worked. I’m proud of everyone.

I hope (HOPE) to get to it next week! But don’t misunderstand my participation. I love EVERY one of you who have helped in whatever role you played!!!

As Michael wrote in his final email “Whatever role you played—friend, family member, colleague, lover, bridge partner, co-conspirator—thank you. Thank you for humoring, befriending, entertaining, enlightening, enabling, abetting, loving, and/or tolerating me. My life was richer for your presence, and I hope you got something in return.”

Derek Maingot accepts the Ice Bucket Challenge at Burning Man 2014
Derek Maingot accepts the Ice Bucket Challenge at Burning Man 2014

I did old friend. I did.