Democrat Photo by Jeanne Sager
THE THREE TOP managers of Catskill Regional Medical Center are, from the left, Stuart Hirsch director of critical operations and trauma coordinator; CFO Nick Lanza; and Chief Nursing Officer Kate Thomas.
By Jeanne Sager
HARRIS December 15, 2006 They’re calling it “mission possible.”
But is it?
“It” is the recovery of Sullivan County’s only hospital from a financial crisis many have called the worst in its more than 30-year history.
“They” are the three members left manning the ship.
It’s an administration team thrown together as first Chief Executive Officer Art Brien was forced to resign in September, his successor and former Chief Operating Officer Larry Cafasso was “terminated” in November and Chief Nursing Officer Patty Armstrong was demoted in the same week the hospital cut 72 members of its staff.
Although Interim Chief Operating Officer Ed Wenzke is also shouldering some of the burden of the hospital’s day-to-day operations, he remains an employee of Navigant, the Illinois firm brought into Harris in October to turn the hospital around.
That leaves Nick Lanza, vice president and chief financial officer (CFO) of the hospital, as the senior administrator on staff.
Lanza, who spent 20-some years with the New York State Health Department and worked in administration at Brookdale Hospital in Brooklyn, came to CRMC in August 2003 from a physicians’ practices services company in New Jersey.
With a background in finance (his bachelor’s degree from St. Francis College in Brooklyn is in accounting), Lanza served as the hospital’s director of physicians services until May 2004 when he became interim CFO.
By January 2005, the board of trustees had taken “interim” from his title, entrusting Lanza with finances of the corporation.
Although Lanza was forced out just weeks before Brien’s resignation, he was hired back by the board in September.
Next in line is Kate Thomas, the consultant brought in a year ago who was named chief nursing officer last month.
Thomas, who earned her bachelor’s degree in nursing from the University of North Carolina at Chapel Hill and a master’s degree in healthcare management from the Internet-based University of Phoenix, came to CRMC from the Warwick Central School District.
An Orange County native who now lives in Rock Hill, she earned a full-time position as clinical director of the hospital’s mental health unit in March.
Rounding out the trifecta is Stuart Hirsch, a 1983 Monticello High School graduate who has been associated with the hospital “at intervals” since 1988.
A registered nurse, Hirsch is currently director of critical operations and trauma coordinator at CRMC.
Hirsch, who earned his bachelor’s degree at Binghamton University, has nine years of air medical experience as well as his certification as a commercial pilot.
He spent a portion of his time away from Sullivan County working for the federal government providing healthcare on a Navajo reservation in Arizona.
Although the board of trustees has ultimate control over what happens at CRMC, Lanza said it’s up to the small band of administrators to run the hospital.
“There’s a difference between management and governance,” he said.
It’s up to the board to govern, the administration to manage.
“They should not micromanage; they should entrust us to run the hospital,” he said. “But they should hold our hands to the fire and make sure we do.”
But with a community that’s been calling for heads to roll specifically the heads of the board members who watched as the hospital fell into dire straits Lanza said people need to be aware that the board is making real changes at CRMC.
“They wiped out administration,” he said. “Everyone is gone except for me, and I was brought back.
“They went out and went through the process of bringing in a restructuring firm,” Lanza continued. “And Navigant wasn’t chosen out of the phone book.”
The firm, which has also received criticism in the community, was interviewed by the board along with every other company credentialed by the Dormitory Authority of the State of New York (DASNY), the hospital’s largest creditor.
The board approved Navigant, and the decision was approved by the NYS Department of Health.
Brien’s departure and Navigant’s hiring was accompanied by the switchover of Board President Richard Baum from volunteer to hospital employee at a fee of $5,500 per week for 20 hours of work each week.
Because that arrangement has been under scrutiny of the public, Lanza said the community should know the board felt they needed a leader.
“The board felt there was a void at the top,” Lanza noted. “They needed someone to be their eyes and ears.”
But, he hastened to add, Baum is back on the board, off the hospital payroll and the change was made sooner than originally planned.
And, Thomas added, residents who have extrapolated out the $5,500 per week figure to represent a yearly salary of $286,000 have to realize there was never a plan to carry Baum’s position into the long term.
The administrators sidestepped attacking their predecessors, but insinuated the board wasn’t operating with enough information in the past to prevent the current financial crisis.
“It’s administration’s obligation to provide the board with information and monitoring tools,” Lanza said.
There are benchmarks provided monthly to the hospital’s board of trustees comparing CRMC to healthcare facilities of like size. But the meat of those benchmarks has to be put into the context of CRMC by the administration.
“The board itself is only as good as the information it receives,” Hirsch noted.
With Brien at the helm, the current administration said the board was not receiving the full scope of the information.
What information was missing, they wouldn’t say.
The “flow” of information is what they focused on information now comes from the administration as a whole rather than being funneled through a CEO.
Even that process couldn’t be explained administration has always been called upon to attend board meetings and report to the board of trustees.
But Lanza said both the “scope” and “nature” of the information provided at each board meeting has increased significantly.
“There’s a transparency there that didn’t exist before,” Hirsch added.
But that’s where the administrators’ “look back” ended.
“I can’t focus on the past,” Lanza said. “I have to focus on the here and now and the future of this organization.
“I know the community is focused on how we got here, but there’s no time in our day to focus on that,” he continued. “I know the community wants to focus on the prior administration, but I’ve been trying to stay clear of that whole issue.
“It’s not our style to go bad mouthing … we have too much to focus on here.”
As the hospital’s spokesperson, Lanza said he has begun to make the rounds to civic organizations in the community. His plan is to bring with him a small presentation, then sit back to listen.
“What we provide here, can we do it better by listening to the community and looking at our colleagues out there?” he asked. “I’d certainly like to listen to their thoughts, evaluate them, and, if it’s financially doable, do it.
“There’s space in this hospital we need to fill with revenue producing services that this community needs,” Lanza said.
“All we ask is the community support the hospital,” he continued. “We’ve been trying to gain their trust … if we make a mistake, we’ll own up to it.
“We’re not perfect,” he noted. “We do make mistakes, but if we own up to it and correct it, that’s all you can ask.”
Although the administrators declined to comment on specific plans to increase revenues, Thomas said there is a renewed effort to bring grant money into Sullivan County.
“We need to work smarter,” she said. “In a not-for-profit, you’re supposed to put your profits back into the hospital… when you don’t have any profits, you go to grants.”
Thomas dubbed the process “the three Rs.” In the past year, she said, there’s been a review of the hospital’s problems, followed by the restructuring of recent months.
“That was very traumatic and painful, but now we’re into the recovery phase, which is very intense,” she said. “The board isn’t the issue here; the issue is taking care of ill patients.”
“We need to focus on the people of Sullivan County,” Thomas added. “We are a hospital. There are people living and dying in Sullivan County, and we can affect that.”
Taking the Steps To Fix What's Wrong
By Jeanne Sager
HARRIS Crises are nothing new for hospitals the very place we all go when something goes wrong.
Even as Catskill Regional Medical Center is mired in a financial mess, the hospital is carrying on a 30-year tradition of treating patients.
Between the Harris and Callicoon divisions, CRMC has been home to 13,000 births and more than half a million emergency room visits in 30 years.
“We’ve treated the volunteer firefighters, the various police departments, the ambulance corps volunteers,” said Chief Financial Officer and Vice President Nick Lanza. “We’re here 24/7/365, and we turn no one away.”
Indeed Catskill Regional loses more than $3.5 million a year treating the indigent of Sullivan County in part because Medicaid doesn’t reimburse hospitals dollar for dollar for patient care.
And they’re sinking money into the hospital even now to improve care. A new device installed in the emergency room (ER) measures cardiac enzymes in 15 minutes to determine if a patient is suffering a heart attack.
It’s already decreased the time it takes to get patients to a cardiac cath hospital by as much as four hours.
And CRMC is well on its way to becoming the first rural trauma center in New York State to be recognized by the prestigious American College of Surgeons.
Stuart Hirsch, director of critical operations and trauma coordinator, calls the emergency room the “face and door” to the hospital.
With rural roads, Sullivan County represents a complex challenge for emergency room workers accidents happen frequently, and carry with them traumatic injuries.
Sullivan County has the dubious honor of topping the Hudson Valley with its percentage of motor vehicle accidents that prove fatal.
In response, CRMC has put its focus in the past year on ensuring the “golden hour” to patients who need care for traumatic injuries.
That time period is the best chance a patient has for survival after a near-fatal injury, Hirsch explained.
With a trauma team put in place in late December 2005 and a relationship set up with Westchester Medical Center, Catskill Regional is creating a trauma center.
It will be a rural equivalent of the Valhalla-based level one center at Westchester.
Key to the success of this trauma system is the hiring of an air medical team which will be put in place at the Harris facility in January to fly patients directly out to Westchester.
The relationship with the larger hospital also offers opportunities for CRMC staff to receive additional training, enhancing the quality of the emergency room which is already staffed by the same New Jersey firm that provides physicians for the ERs at Westchester, Nyack, and other larger hospitals in the region.
“They’re going to get the same quality care here that they’re going to get in Westchester,” said Kate Thomas, chief nursing officer at CRMC.
CRMC is also focusing on reducing ER wait times by turning a former 13-bed Intensive Care Unit into a Rapid Observation, Admission and Discharge (ROAD) Unit.
Patients who physicians want to admit are taken to this new unit, where they can lie in a real bed (rather than a stretcher), watch free cable television and talk with nurses to be admitted in private.
It’s a concept pioneered at CRMC that is catching eyes across the nation.
“We’re utilizing best practices from across the nation to better our hospital, but we’ve developed best practices in our own hospital and we’re being recognized for that,” Thomas explained.
Although Thomas called the recent “rightsizing” of the hospital, with layoffs of 72 employees, “traumatic and painful,” CRMC is reviewing its place in the community as it recovers.
In doing so, hospital’s administration has put its focus on the ER, the operating room and the newly refurbished maternity ward.
From there, there’s a ripple effect into the rest of the hospital, Thomas noted.
The $4.5 million maternity ward which was built just as many mothers were pulled out of the hospital by their Crystal Run Healthcare obstetricians in June is very slowly seeing the census increase.
Lanza hopes the state-of-the-art ward will be enough to convince moms not to make the trip to Horton when they’re in labor.
“Providing great care for the mom is paramount,” Lanza said. “Mom is in control of all the medical decisions for the whole family.”
If they make Mom happy, CRMC hopes they’ll get repeat business.
And that’s key to keeping the hospital running.
The prestige that comes with accreditation from the American College of Surgeons won’t pay the bills.
When asked what will increase revenue, the administrators declined to comment on their plans for the future, saying only that there are a number of proposals on the table of the board of trustees.
That board is now at its charter minimum of 12 members and reviewing applications for new members.
Lanza said he’d leave the question of what makes an applicant “qualified” up to Board President Joyce Salimeno.
The search is also on for a new hospital CEO with board members, community members and medical staff on the search committee.
When the new administrator will step in is anyone’s guess.
“We’re going to take as much time as needed to get the right person,” Lanza said.
He promised the hospital would do “due diligence” in reviewing the applicants’ histories.
Asked whether the hospital would be willing to hire another administrator like Art Brien who hospital staff said was fired by his past three employers before being forced to resign from CRMC in September Lanza said the new CEO should be someone who has had experience with hospitals in financial distress.
The very nature of a rural hospital calls for that, he said.
“It’s a difficult business to run,” Lanza noted.
He said the hospital’s success is in the community in whether or not the “new” CRMC gets support for the advances they’re making in improving patient care.
The hospital wants new healthcare providers to sign on to its medical staff, and they want new patients to walk in the doors.
“It’s all about community perception and community confidence,” Lanza said.