Ocktoberfest KVHD board meeting: all beer and sausage

“…Because we have a lot of people in this community who need the assistance of a psychiatrist,” Tim McGlew with the quote of the night taken out of context, but even in context it’s still funny. Read on.

One week ago we had the Kern Valley Healthcare District Board monthly board meeting and I’m still reeling from what I heard that night. I wanted to make sure to cover this properly and have spent much time pulling quotes, as I will let them speak for themselves.

The issues which were at the forefront of the meeting were some I had identified almost a year ago, the cost of the skilled nursing facility, a risk assessment of the SNF, staffing, paying the revenue bond debt, and now a few others.

The new “bad debt” caused by the uninsured who don’t pay their bills and are recalcitrant about filling out forms to apply for charity programs where the hospital receives reimbursement.

And, the annual increases in Medi-Cal have been frozen by the state, thus taking away nearly a “half a million dollars” we put in the budget and thought we would have to spend. We never had the money, but we expected the increase, with obviously no contingency plan, like we always do.

Now we have to live with increases, but with no increase in reimbursement, according to our CEO, Tim McGlew, and verified, by our CFO, Chet Beedle.

Then there’s the fact that we have only enough cash on hand to run the hospital for five or six days if we’re lucky.




(And you, the audience thought it was just going to be about the pharmacy, didn’t you? We should be so lucky. )




No, Chief Financial Officer, Beedle, in no uncertain terms announced trouble paying the bond debt, and looking to the future, next August when we pay the big chunkaroo, 1.1 million, it will be amazing.

So, where do we start here. Well, there are some new beds being put in around the nursing facility, and Medicare won’t be paying for them. However, local gardeners will be volunteering their time to work and actually furnishing these aesthetic upgrades, flowerbeds, in three of the courtyards.


"I represent the KRV Garden group and our group is going to be doing a beautification of three of your courtyards and we are going to be calling them, healing gardens," Shirley Real explained to the board, while holding up a copy of the Kern River Courier talking about the media coverage on the group.

(Healing gardens, I like that whole concept. We already have the "healing murals" but that cost a bit more. Always interesting timing.)

Shirley Real told the audience about her informal garden "club's" project, which will bring in new plants, fire safe types, low water, and there will be a grand opening in March as spring is the time to see the project bloom.

(I know what you’re thinking who cares, give us the gory details. These gardeners are trying to do their part for the community, for the hospital and its residents, so they get a plug.)


And, of course, Alicia Audette, known for her very positive reports to the board on the activities of the hospital’s auxilliary group. The auxilliary runs a very profitable thrift store off the Lake Isabella strip.

Alicia Audette, showing her muscle as she reports high earnings at the thrift store.
"As usual, we are doing very well, our daily revenues have gone up."


The Hospital Foundation reported the Peddler’s Fair went well, and Mary David, Director of the Youth 2000 teen pregnancy program, propagated information regarding that program.

Chief Clinical Officer, Cynthia Burciaga, took to the podium, and an information waterfall spilled out. She gave us a lot of details regarding her work with the skilled nursing facility, such as staffing milestones, and we were introduced to our new Director of Nursing, Michael Goospy.

"He comes to us from Carlsbad, New Mexico, with a significant level of experience in the Skilled Nursing Facility areas as well as some acute care experience in critical care. He's been such a welcome to our healthcare community," Burciaga told the board audience.

"And he's jumped in looking at the policies and procedures, meeting with various personnel, becoming acquainted with each resident and their specific needs..." she added.

Goosby, who is taking over a critical position in the skilled unit, quietly received his applause, which he deserves considering the job and location thereof.

Burciaga then lead into the story about a recent look around by the Department of health services.

"We did have a visit from the state yesterday, we did good. And overall we're doing very well consistently. You know they come here and there, find the time, to just check up on things," she explained.

"We'd like to share with the staff and community that when the state comes to visit it's not a less than positive event. When the state comes to visit they share experience with us, they see current trends, just checking up on the various practices to make sure we are following those and other items...they come in and look at the staff they are very well pleased with our practices."

(And where was the state health department in 2006/2007 sharing their knowledge and practices? Now, they just drop in for a "visit")

Burciaga, who works sometimes personally in the nursing center when the need arises, said that staffing is going well, although the nurse's aides are opting to go to school to achieve the next nursing level, LVN, and some of the LVN's are going back to become RN's, so there is some shifting of staff going on.

The CCO said that the nursing facility is now meeting all its staffing requirements and has even exceeded them. "And our average patient care hours per day is 3.24 and so we stay above the 3.2 level."

Can we get our flu shots? If so, where and when?

Those questions currently cannot be answered in this story (get info soon), but Burciaga broached the subject talking about the precautions the hospital will be taking during the flu season, and with H1N1 on the loose. Gloves, masks and handwashing, as well as flu shots for staff and residents.

But where do we get our flu shots. According to Burciaga, there will be no "drive thru" clinic through the hospital, and patients are being urged to contact their doctors about the problem.

Currently, Rite Aide is out of flu shots but Sienna Wellness is hoping to have shots for their patients by November, as the shots are on order, even the swine flu vaccine.

(More on this topic, as I need to speak with Public Health as we have a high concentration of seniors who will likely need flu shots. And we need to know where to find them. Yeah, we might actually have to go to Bakersfield.)

A few technical problems didn't stop the chairwoman

As Kathryn Knight opened the meeting, the microphone apparently was borrowed from a local "jack in the box" as the crackling came out of the speakers after each word Knight spoke.

(I noticed a maintenance man there, he was more concerned with the cord to our video camera than he was about the distortion coming from the PA system. I'm sure he hasn't been cross trained yet, as is planned for the staff.)

(My time is running short here as the electricity is out because two drops of rain poured on the valley which always causes outages. I'm on my battery watching it drop while I write in the dark. So, we will see what happens, I've only got 35% to go...oh no.)

Secretary of the board, Victoria Alwin, asked for clarification on the consent agenda, as there was a question as to the pharmacist dosing Vancomycin, an aminoglycoside antibiotic which is known to be ototoxic and can cause permanent hearing loss.

I, myself, have taken Gentamycin, another aminoglycoside, and now I have no visual stability, balance, and it is permanent damage.

I'm glad that there has been discussion as to how to administer and dose these very strong and dangerous antibiotics. These types of antibiotics are used in cases of serious infections such as staph.

Two reporters narrowly missing each other at the meeting. "Don't look at me and I won't look at you," describes this close encounter of the lawsuit kind.

As Knight's microphone screeched and scratched, Dr. Robert Gross lent her his microphone, then needed it back later to ask Chet Beedle a few questions during the financial, or lack thereof for brand new reasons, report.

Chet chat, oh my what's that he said?

Beedle opened the report, "The Kern Valley Healthcare District had a very difficult month in the month of August, relative first to volume, the volume was down, under what it was the same month the previous year, in virtually every venue."

But not every venue, as Beedle surprisingly brought up a positive posting for the nursing center. "...for the first time in fours years the skilled nursing facility has made money."

Beedle said part of that was that the hospital has taken out most of the traveling nursing and registry, which sent staffing costs through the roof.

"The SNF can function, it needs, I've always said, it needs 70 patients a day and we almost had that at 69.15 and it needs no registry utilization and it had a small amount, but it was under its budget in registry utilization and it kept the salaries in line. Those three things together, you put them together, you will do well financially in the skilled nursing center."

(I think he left out the part where where we had millions in registry, consultant firms, and contractors, taking money by the bucketfull out the door to some other community. Maybe that has something to do with our current condition. So, why didn't we do this before?)

Chief Executive Officer, Tim McGlew, also talks about the closing the barn door after the horses got out, by doing a risk assessment in the nursing center, later in the story.

(I'm under 10% battery power, so we are both going to have to wait for Southern California Edison to get the power back on.)

It was a miracle

Well, we did it, we paid the bond reserve payment this year for both February and the month of August. Beedle initially reported at the beginning of the year that we would have to take money out of the reserve account which is part of the contract for insuring the debt, with Cal Mtg.

How we did it, was not explained, and the question was asked over and over again, "how can we make this payment without taking money from the resesrve, which Cal Mtg. doesn't like?"

The answer came a few months later, when Beedle said we did indeed have to take 155K out of the account.

But we paid our large million plus payment in August, with only a portion of the reserve.

"We made that payment which I think was a feat in itself," Beedle said.

"What that means is we had to dip into our cash, to make our semi-annual bond payment of 1.1 million dollars."

Cash, what cash?

The CFO explained that other hospitals on average, (he says he likes to compare our hospital with others around the state and nation, bringing us gems of comparative information.) have around 23 days the can operate with their cash on hand.

However, KVHD, has hit rock bottom at five to six days of viability without any money coming in.

"We could operate with the cash we had for six days...a year ago it was twenty days."

The economy and the uninsured: our newest excuses

I don't think anyone didn't see this economy coming down like a brick fireplace during a temblor, but it seems the hospital didn't quite plan for the situation.

Now the complaint is that more people are uninsured here in the valley, (I'd like to see the statistics on that for reference) and they utilize the emergency room services because they not only aren't insured, but they have no money to pay the sliding scale the hospital offers.

These people need to fill out "charity forms" for programs offered through the state so the hospital can get some sort of reimbursement. Otherwise, Beedle said, the services rendered would be part of the "bad debt" mounting at the hospital.

"They can have their bill reduced or written off."

Beedle talked about the amount of money this is costing the hospital, which should make you swoon: $300,000. Somehow, I'm not quite as impressed as I was when I added up the consultants fees and it came to "three million" dollars.

(It reminds me of the scene from Austin Powers when Dr. Evil asked for one million dollars in ransom)

I do, however, enjoy the new thriftiness being utilized in accounting at KVHD, but so much money was wasted over the last three years, and now Mr. Beedle talks about what can be done.

"Chet, I know you can't look at a crystal ball, but what do you think the future holds for us in the next six months, or in the future..." Dr. Robert Gross, DO, board member and hospitalist asked the CFO.


"What the hospital can do to deal with this economic climate, one of those things is looking at services which are non productive...one of those things is a staffing reduction. One of those things is other types of things that they do. For us, relatively speaking is the reduction in variable expense is limited. The reason I say that is because the number one, the largest share of variable expense is labor."

(That statement scared me a bit and I'm sure would do nothing for the morale of the employees.)

Dr. Gross then asked, "Do you expect that the number of uninsured patients coming to this hospital are going to continue to rise?

"I don't know if it's going to continue to rise, but it's not going to go down."

"And how long could this hospital absorb that?" Gross replied.

"That's an interesting question, that goes back to the statement I had before, if we don't increase the revenue in ten months...

Then CEO, Tim McGlew, wedged his way into the conversation.

"I think I'm going to jump in on that. The bottomline, obviously, we can't be in a position where we are standing still, we have got to find new sources of revenue, we got to look as Chet said before, things that are costly as like you know, we really need to make some decisions and we're going to talk about that later tonight." (the pharmacy)

McGlew expanded his explanation, into needing to start new programs such as wound care and pain management. He also talked about new specialists coming up to the valley.

"We can't just stay static we have to change the scope of things and find new choices," he said.

Beedle shared his hidden wisdom regarding asnwers to these pressing issues. "The real secret for us is volume." (Ssssshhhh)

I told Beedle I had read an article in the Bakersfield Californian, an AP story, regarding Medicare cuts. I asked how that would impact our nursing center.

The CFO explained that Medicaire does not cover most of the residents, and I remembered the coverage only lasted maybe 100 days for rehabilitation.

He said that the Medicare patients are usually utilizing "swing beds" which are paid by Medicare, paid well, and that isn't changing.

(Maybe that accounts for why Sierra Kings District decided to add swing beds there in the plan they concocted before filing for Bankruptcy.)

So, good money in swing beds from the feds, but cutting out other ancillary programs that help residents of nursing homes get proper attention.

What will we do about Cal Mtg. ?

Beedle used the phrase, "limp along," which means that something is going to take a hit, this time probably not the nursing center, as there might have been a learning experience there.

But Beedle wouldn't be considering taking on Cal Mtg. would he?

"The real issue is going to be, we're having difficulty funding our long term debt, I think we're going to make it for the first annual payment in February, I'm extremely concerned about the August payment that where the rubber is going to meet the road."

He went on to explain, without invoking Cal Mtg., what could potentially be done about this shortfall.

"Understand there's our half million in reserve there but we're talking about 1.2 million dollars. What happens if we don't? There's insurance that we bought when we did the bond, the will actually pay for it, so it will get paid. But there are all kinds of that go along with it."

Yes, there are many things that could happen if we didn't pay our friends at Cal Mtg. I'm sure you can read about it on the blog or go on the web and read the state plan for 2007: that should help you understand the situation we are in.

Beta Group: Risk management assessment of SNF

In his montly report, CEO, McGlew, happilly spoke of a "free" service given by the hospital's liability company which assesses risk potential and offers help in reducing the possible problematic outcomes.

(Isn't that great? Wish we would have done it before, but McGlew said Beta had just come up with this nursing center type survey. Gee, Beta, I guess its better to fight a dozen lawsuits than it is to survey the businesses you insure. I don't know maybe it works out for you.)

"The general findings from them was excellent, the team that was here was extremely complimentary of the staff and the quality service they provide. They did give us a list of suggestions to continue to make improvements, Cynthia is working with her team on that," McGlew explained.

McGlew updated on the radiology contract with Truxtun Radiology to do our digital media over the computer, as Dr. Eleanor Frazier, our on-site radiologist, retired last month.

Things seem to be going well, he said. And they will be looking for coverage for the night shift too. That contract will come to the board soon.

McGlew then announced the hiring of a psychiatrist for the nursing facility who is now being utilized at the Rural Health Clinic (I hope all who work there get a discount and use him) seeing patients, "because we have a lot of people in this community who need the assistance of a psychiatrist."

What is the fate of our "poor side of the lake" pharmacy?

McGlew made his reccomendations to the board that the pharmacy should be closed as it is losing money and not able to fulfill its obligations to the community.

The idea is to move out of the building and move the pharmacy into the hospital. (we could put it right in the hallway between the cafeteria and acute care) This way it would serve the residents, employees, and the patients.

However, Kathrynn Knight, was not as keen on the idea and asked questions about the accounting of the costs in the pharmacy. More questions need to be asked, and we will have the opportunity, as four board members voted to look at the situation prior to closing.

"The Drug Store" in Kernville, would take much of the brunt of the overflow if indeed Mesa Clinical Pharmacy is found to be unsalvagable.

The hospital would then have a building with no pharmacy license tied to it, and no stock, and they could sell, lease or even do something like another thrift store. Gosh, they do well.

We will go into the details on the blog as to the pharmacy, it's credit problems, and the lack of flu shots here in the valley.

Brad Armstrong, the poster boy for term limits, voted to take another look at the pharmacy rather than just cut it out of the picture.

He even asked the CFO if they had been doing any marketing of the pharmacy.

(Our motto: You'll get your medicine on time, if you pay for our shipment. We only do COD)

There are currently only three wholesalers who dominate the pharmaceutical industry and we have not made them happy by slow paying. But other pharmacists believe that Mesa Clinical is viable and could make money.

CCO, Burciaga, said in the event the pharmacy does close, the employees would be able to work at the hospital. Right now, the pharmacy staff is getting cuts to their hours, but staying on anyway.

Bob Jamison, the only "no" vote to take another look before closing the only pharmacy serving the southside, seemed to be unimpressed and rather bored last Wednesday.

Sorry, Bob, we didn't mean to wake you.

More to follow: "A Patient's Plea" , Youtube videos, and the final cut of the 2007 board meeting.

Next week: the countdown to court continues, why can't I get public info and answers, The Guardians, and "where they are now."