The coming tsunami from a healthcare provider’s perspective

Earlier this week I contacted a friend who is a healthcare provider in an urban Northeastern city. They offered to share their personal experiences and perspective on the pandemic as time and energy allow. I am grateful for their insights and commitment to serving the public. I promised that they would not be identified.

March 19, 2020
Let me preface these reflections by stating that I am not truly on the “front lines” at this moment, but I do work with both inpatients and outpatients at a large hospital in the Northeast.  My job brings me into direct contact with people who have infectious diseases, some of which may be undiagnosed, on a regular basis.  In the past, I worked in EMS through the HIV/AIDs crisis, the Swine flu, SARS, H1N1 and was never as apprehensive as I am right now.

The anxiety and fear here are palpable.  It’s like waiting for a predicted tsunami, but a tsunami scenario from which there is almost nowhere to escape.  Most of my social circle (which includes medical and non-medical people) are experiencing this same feeling.  If you aren’t concerned you should be.  Those of us providing healthcare at any level have an increasing sense of dread and worry about what is happening. We wonder about tomorrow, next week, next month and what we will be doing – fear of the unknown.  We hear the cries of our colleagues in Italy and other countries who have more sick patients than they can handle, making heart wrenching decisions over who can be saved, trying to allocate scarce equipment resources appropriately, and daily having to choose who will get the chance to live and who will be left to die.  It’s a situation that medical providers face in any disaster, but this pandemic may last months.  The weight of all of this is already taking a physiological and emotional toll.

As we reduce and eventually eliminate outpatient services and move towards telemedicine provider visits, it means that healthcare providers will most likely transition to other areas of the hospital to supplement staff.  Imagine being told that instead of your marketing job, tomorrow you will be doing engineering. You know the product and its capabilities, but you don’t know its design or how to troubleshoot problems when it breaks down.  Yes, some skills and knowledge can be carried over to another role, but there is a big learning curve…and in this case lives are at stake.  This is a scary situation for care providers because we pride ourselves on providing safe, competent, efficient, and compassionate care.  But as patient numbers increase and providers become sick, this situation is inevitable.  Angst. Worry. The feeling of impending doom.

While much of the public is shielded from hourly updates on COVID-19, we are not.  Our protocols, procedures, staffing, equipment, and communication with coworkers have all changed and continue to update throughout each workday.  As the daily stress levels mount for us, we stare in disbelief and horror at the news watching thousands of people on the beach in Florida, or out in Spring Break mobs in bars, carelessly crowding each other and spreading this virus.  We have difficult conversations with friends and loved ones who still may be amongst the “non-believers”.  We know it is real.  This is not the flu.  This is not hysteria or the fault of the media.  Get your head out of the sand before you infect your elderly parents or grandparents, your neighbor, your friends.

Some may not survive this.  Some of my coworkers may not survive this.  I don’t want to see your loved one die alone – yes, ALONE. Think on that for a bit.  That thought terrifies me and it should terrify you.  We have the benefit of learning from the experiences of China, South Korea, and Italy.  They have told us to listen to their lessons, their mistakes.  Let me tell you that I wept listening to health care providers talk about their dire situation.  It’s the recipe for career ending post-traumatic stress disorder.  I have already experienced enough sadness in the healthcare field in my prior role as a street EMS provider.  I don’t need to take on more.  But that is what the healthcare providers need to do, and what we are expected to do.  I am willing to do my part, to go where I am needed, to do anything I can to help you or your loved ones in this pandemic.  Please do your part and stay home.  My life may depend on important action.

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.