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Employees would be called off duty on low-census days on a rotating
basis if the board adopts the proposed amendment.
Current policy is for off-duty calls to be made on an "equitable basis."
An employee may volunteer to take low-patient census days and not
jeopardize their status. Vacation benefits, if available, can be
utilitzed when an employee is on LPC. Those provisions would not be
changed.
The June census was up over last year, but the year-to-date census is
down slightly from 1994. Routine patient days were 2,008 last year, as
compared to 1,886 through June this year.
Nursery days are down from 134 to 113. Cash collections are down
$474,000.
Salaries and wages are down $233,372 for the year.
Dr. Kai-wood Ma has signed a contract to open a family practice in Pecos
and deliver babies. He and his wife plan to be here Friday to look for a
house.
Other agenda items for the 6 p.m. meeting in the hospital classroom
include the annual balancing statement and certified totals from the
Reeves County tax assessor collector; consider indigent care program
appeals policy; medical staff report and administrator's report.
Directors in their Tuesday meeting accepted the certified appraisal of
$355,386,020 submitted by Carol Markham, chief appraiser for the Reeves
County Appraisal District. In 1990 the appraisal was $452,195,050.
Elfida Zuniga, county tax assessor-collector, estimated 1995 collections
at 91 percent of taxes assessed.
She collected $1.3 million of the hospital district's 1994 tax roll,
plus $43,237 in delinquent taxes.
Current 1994 taxes that became delinquent on July 1 is $118,012.
Delinquent taxes owed for prior years, beginning in 1989 when the
district was created, total $266,462.
Jeannette Alligood asked how long taxes are delinquent before action is
taken to collect them.
Zuniga said that the collection agency sends letters as soon as a
property becomes delinquent. If the value is high on property that is
four years delinquent, they may file suit.
However, on property that has a low value, it is not worth the court
costs to file suit, even when taxes are owed for 10 years or more.
"One of my concerns is that they owe for four five years and taxes are
more than anybody could pay," Alligood said. "if we pursued it in the
first year, it could be where they could pay it."
Questioned about the collection firm, Zuniga said that each governing
body is responsible for choosing the collection firm it wishes to use.
Reeves County commissioners are considering a change from the Austin law
firm it and the hospital district have used for years, she said.
Alligood said the bonding company looking at refinancing the district's
bond debt "wanted to see us take action to be more aggressive about
collecting."
Garcia said the board is not satisfied with their performance, "but we
are trying to learn what power this board has in selecting or pressuring
someone."
As tax revenues and operating income falls short of budget projections,
the board voted Tuesday to adjust its staffing policy to allow
supervisors to call employees off duty on low patient census days.
Employees may be called off duty (without pay) during a shift and placed
on low patient census or placed "on call" for the remaining shift. A
provision that invidivual employees be placed on LPC only on shift per
week was deleted.
Carolyn Riley, chief executive officer, recommended LPC call offs be
made on a rotating basis, but board Chairman Raul Garcia objected on the
grounds that might "change the power of responsibility of the
supervisor."
Riley said she chose the word "rotating" because "I am not sure what
equitable means. The only fair way I know is to go through and rotate
unless people volunteer to be off," she said.
"If we use this sentence `on a rotating basis,' we are dictating to this
department head what he must do, and if that's the intent of using that
word, I am opposed," Garcia said.
"Equitable is good enough," Riley said.
The board agreed to leave the term "equitable" in that provision in
place of "rotating."
Riley said the off-duty calls will apply to every staff member who is
not needed on a particular shift, including administration, medical
records and housekeeping.
Laboratory and radiology staff may not be affected because of
out-patient services offered by the hospital, Riley said.
An employee may volunteer to take LPC and not jeopardize their status.
Vacation benefits, if available, can be utilized when an employee is on
LPC.
With several doctors on vacation or attending conferences in recent
weeks, the census has been low, but is starting back up again, Riley
said.
Riley said that Dr. Kai-wood Ma and his wife will arrive in Pecos Friday
morning, and she would like them to have a social visit with board
members, possibly Friday night.
Among the entertainment possibilities is a visit to the cantaloupe
festival on Saturday, she said.
Dr. Ma has agreed to open a family practice and take additional training
in obstetrics so he can deliver babies. At present, Dr. Joseph Darpolor
is the only local doctor delivering babies.
Two radiologists have indicated an interest in moving here, but both
will take some time, Riley said. She is working to fill that position on
an interim basis.
Riley reported that an ambulance sustained about $1,000 damage when it
was involved in a minor accident July 27.
While transportating a patient with an injured thumb to Odessa, the
ambulance driver swerved to miss an animal in the road and scraped a
guardrail on I-20, Riley said. No personal injuries resulted.
After learning the district had no physical damage insurance on the
ambulance, Riley arranged for $500 deductible coverage at $436 per year.
Chairman Garcia questioned why the amublance driver was not present in
the meeting, as he requested of nursing supervisor Sheila Apps.
Riley said that board members should come through the administration
rather than go directly to an employee for information, to avoid
confusion as to who the employee answers to.
Garcia said he is concerned that the hospital had no insurance. "Don't
you agree that this is something this board needs to be concerned with,
and that your office should have known about this?" he said.
Riley said that other administrators probably did know aboutit, but with
everything else that is going on, she had not been made aware of it.
"We have been handling things as they occur," she said.
Garcia said there seems to be a question as to what director in the
hospital is responsible for the ambulance. He suggested it be placed
under the plant engineer. "He has greater knowledge than anyone in
nursing service."
Riley said it might make sense to assign all vehicles to him.
Pharmacist response to requests for bids to provide services to the
indigent care program has been mixed, Riley said. Bids are to be
submitted by August 18 and will be available for board action on August
22.
Honeywell's energy audit report for the past year shows the program has
saved the hospital $22,796 in energy expenses. Electrical power usage
has been lower each month than the same month in the prior year.
Quorum out, new managers considered
Directors for the Reeves County Hospital District will consider
management proposals for the hospital and collection of delinquent taxes
in their regular meeting at 6 p.m. Tuesday.
Quorum Health Resources, the current management firm, has helped the
board solicit management proposals from five hospital systems: Memorial
Hospital in Midland, Texas Tech University Health Sciences Center in
Lubbock, Methodist Hospital Systems in Lubbock, Shannon Medical Center
in San Angelo and Odessa Medical Center.
Management fees budgeted for Quorum in 1995 is $138,000, plus salaries
and benefits of $150,395 for a chief executive officer and finance
director.
The board will also consider bids on pharmaceutical services for the
indigent care program and consider an agreement with Alexander Kovac
M.D. to provide backup teleradiology services from his new home in Big
Spring.
Dr. Kai-wood Ma has agreed to open a family practice with obstetrics in
Pecos by October 1. However, he is not licensed in Texas, and CEO
Carolyn Riley said the licensing process may be lengthy if the hosptial
does not provide legal intervention.
In a previous intervention, the hospital paid $8,000 in legal fees. The
board will consider providing legal assistance for Dr. Ma.
His contrct calls for the hospital to reimburse up to $1,000 for Texas
licensing expenses.
Under that contract, the hospital has agreed to guarantee Dr. Ma net
income of $11,667 per month for the first 12 months, plus up to $7,000
for moving expenses, a stipend of $5,000 during the six-week OB training
period and $2,500 for living and travel expenses during that time.
Should Dr. Ma continue his practice for 37 months, he would not have to
reimburse the hospital.
If he should close his practice in less than 12 months he would be
obligated to repay 100 percent of advances. For 13 to 24 months, the
percentage of repayment would be 67 percent. For 25 to 36 months, 33
percent, and from 37 to 48 months, none.
Reeves County tax assessor-collector Elfida Zuniga and a representative
of Calame, Linebarger, Graham and Pena will be present for a discussion
on tax collections. The law firm collects delinquent taxes for the
district.
In other business, the board will consider purchasing two stretchers for
the emergency room, pay bills totaling $389,696 and hear reports from
the medical staff and administrator.
Riley said preparation of the proposed 1996 budget is "in the home
stretch" and she will request a special meeting of the board for its
adoption.
Lubbock Methodist Hospital System, with whom RCH was affiliated until
recently, offers a rural health care network with more than 52
affiliates throughout West Texas and Eastern New Mexico.
They provide an administrator to oversee local operations, but the board
maintains control of the hospital.
Odessa Medical Center also offers to allow RCH to retain its autonomy,
with an open-ended proposal to provide services in any areas identified
by the board of directors.
They have a similar agreement with Pecos County Hospital's board of
directors, with the board choosing their own administrator.
The agreement provides a broad base of experience and services to the
rural hosptial sufficient to maintain continued operational effectivess
and quality localized services, said J. Michael Stephans, MCH
administrator.
Stephans said that MCH's goal is to retain locally controlled health
care, halt the expansion of area facilities being managed by distant
health care systems, maintain current referrals of MCH medical staff and
retain existing services/referrals.
Lubbock Methodist offers a variety of medical and business services,
plus networking with other affiliates in a similar situation.
Riley also took three proposals for indigent care pharmaceutical
services for comparison. Submitting proposals were Rediger's Pharmacy,
Wal-Mart and Professional Pharmacy.
"I think the board is right to go over the bids, because there are fine
differences," said Leo Hung, Professional Pharmacy owner.
He said another alternative would be to allow Riley to do some research
on a fair market formula and give pharmacies a choice to participate on
the same reimbursement rate.
"Anybody that would agree to that contract, they will come forward and
sign it, rather than competitive bid like this," he said.
Cindy Shores, Wal-Mart pharmacist, said that whoever wins the bid,
anyone else in Texas can say they would like to provide services at the
same rates also.
"That, to me, is more fair," she said. "So if a patient loves me and
hates Leo - you don't want a patient to go to someone they don't mesh
with very well."
Riley said that paperwork is simplified by dealing with only one
pharmacist, and it makes checking the bills easier for the staff. Nancy
Ontiveros has to check the bills from all pharmacies to ensure that a
patient doesn't go to more than one pharmacy and obtain more medicine
than he is entitled to.
The board approved an agreement with Alexander Kovac, M.D. to provide
backup teleradiology services from his new home in Big Spring at $100 to
read a CAT scan or ultrasound and $25 per X-ray exam.
Dr. Spencer from Midland will be providing 24-hour teleradiology
services during the interim period while discussions are underway with
prospective radiologists, Riley said.
Legal assistance to help Dr. Kai-wood Ma obtain his Texas license was
approved on Riley's recommendation. She said that Ma does not have the
resources to pay for leagl help, and it could take him six months to
obtain his license.
She said the district paid almost $8,000 to help Dr. Joseph Darpolor
obtain his license. Both doctors were trained in foreign countries where
records are difficult to obtain.
Dr. Ma is from China, but trained in Taiwan, Rileys aid.
Jeannette Alligood's motion to purchase two stretchers at $3,975 each
passed, with the understanding the hospital staff will try to obtain
stretchers from a federal government surplus warehouse instead.
Riley said that medical supplies are being warehoused in El Paso from
military bases that are closing, and they are available on permanent
loan from the government at no cost to the hospital.
The stretchers were a priority item in the capital budget that the board
froze earlier this year, Riley said.
Besides patient safety, Riley said she is concerned that staff members
may injure themselves lifting patients to the table on a backboard
because the stretchers on hand do not work properly.
Elfida zuniga, Reeves County tax assessor-collector, presented a bid of
$500 for property at 517 S. Pecan that was taken in a tax sale. Board
chairman Raul Garcia said the board would not act on the proposal until
all other taxing entities involved have approved it.
Reeves County Commissioners and the Pecos City Council have approved the
sale, but it has not yet been presented to the Pecos-Barstow-Toyah ISD,
Zuniga said.
Zuniga introduced Rusty McInturff of Calame, Linebarger, Graham and
Pena, delinquent tax collectors for the four entities.
Alligood asked how the hospital district will be affected by the
county's recent decision to use a different law firm to collect taxes.
McInturff said that the hospital district has a contract with the county
to collect their taxes, and the county's delinquent tax collection firm
would serve both entities.
However, the hospital district can cancel that contract and collect
their own taxes, he said. Or they could change the contract and retain
the right to hire their own collection firm as the city of Pecos does.
In answer to Alligood's question about the time frame on collections,
McInturff said that taxes become delinquent on February 1, but the 15
percent collection fee is not added until July 1.
That is when the collection firm begins sending out notices of
delinquent taxes due and demanding payment. Several notices may be sent
before the firm files suit. To determine who to sue, they go through the
roll with Zuniga to identify hardship cases and over-65 property owners.
Suits are filed on a priority basis, with the larger amounts handled
first, McInturff said.
Marcella Lovett asked why the firm waits four years before filing suit
on anyone.
"That's not the case," McInturff said. "We wait on some because, when
theyfirst go delinquent, it is a small amount. We try not to let
anything go more than four years delinquent."
He said the hospital district has 1,000 delinquent tax accounts.
"If I file 1,000 lawsuits in Judge Parks' court, I wouldjust move over
here, because he would have me there every week," McInturff said.
Garcia asked what is the advantage of taking people's property.
"What's an entity going to do with this? Who are they going to sell it
to? If we chase someone out of their property, who is going to buy it,
and where is this person going to go?"
McIntuff said that is why they work with the tax office.
"That's our problem all over West Texas. There aren't that many buyers.
If you look at properties, you will see they are not very good
properties. If they are any good, people will protect it," he said.
"I like the idea of a grey area," Garcia said. "We can't take the humane
aspect out of this thing. This is power that's sometiems abused. I don't
think anyone should be evicted."
"But we have to send the message that we will if it is appropriate,"
McInturff said. "I have had people in $80,000 houses and let us take a
judgment and put it up for sale."
He said he works for the entity and will do what they ask.
"I am not a mad dog out there unchained," he said. "I take a lot of heat
about widows and orphans."
Jesse Prieto asked if McIntuff would do collections for the same fee if
the district cancels its contract with the county.
"Yes, it is standard," McInturff said. "I would sure hate to lose
another account."
Chel Flores made the motion to pay $390,000 in bills as monies become
available, and the vote was unanimous.
Riley said the computer upgrade will be installed Thursday and Friday.
Mike Hathorn, finance officer, said that will not affect his budget
preparations, because all the financial records on a personal computer
in his office.
He said he hopes to have the budget ready for Riley's input on Friday
and for the board on Monday. The board agreed to hold a workshop at noon
Wednesday to go over the proposals.
They will have to set a public hearing and advertise it in the newspaper
10 days in advance of adopting the budget and setting the tax rate.
A second child has symptoms that indicate Hepatitis A as well, said
Michele Cser, physician assistant at the clinic.
Cser said that anyone who had direct contact with an infected person
should have the injection, which heightens the person's ability to
resist the infection for a period of approximately two months.
She said the injections are being offered as a precaution against the
outbreak of a series of such cases, which are common in this area and
usually are seasonal.
"The immune globulin injection is not a vaccination," Cser said. "It
does not confer absolute immunity to the virus, but it helps the
individual resist the disease."
Hepatitis A infection is caused by an entero virus, she said. Exposure
is usually due to eating raw sea food or drinking contaminated water or
exposure to someone who is infected.
"There is no chronic carrier state for this desease," Cser said. "A
person who is exposed can develop the disease 15-40 days after exposure.
The symptoms initially are non-specific like fever, loss of appetite,
vomiting, headache and abdominal pain. Darkening of the urine precedes
jaundice and bowel movement may be light clay colored in children."
In young adults who are essentially healthy the disease is usually not
life-threatening, she said, but it may be necessary to hospitalize a
patient if they have intractible nausea and vomiting that leads to
dehydration.
"There is no treatment for the disease," she said.
Children with prolonged high fevers who become listless and somnolent
should be presented to a physician for examination and evaluation, as
should all persons developing a yellow cast to the skin or yellow/orange
color of the eyes.
Carolyn Riley, chief executive officer, said this morning that she and
finance officer Mike Hathorn are still working to complete their budget
proposal.
After the board makes their suggested changes, the proposed budget will
be on file for public inspection 10 days before a public hearing and
final adoption.
Although the budget will not become effective until Jan. 1, 1996, it
must be adopted before the board can set the tax rate. Tax notices
normally are sent out in early October.
Immunizations were planned because one child was diagnosed last week
with the hepatitis a virus, and another had similar symptoms.
Adults and children who had been in contact with the infected child were
to have been immunized at the clinic with IG supplied free of charge by
the Texas Department of Health.
However, Riley said that because it is a public health matter, TDH will
instead provide the immunizations at a time to be determined.
"If the clinic does the injections, then we are in a position to charge,
where if it is done by TDH, it is my understanding there will be no
charge," Riley said today.
"We don't want people to over-react to this. Certainly, those who have
had exposure need to follow up, but there shouldn't be panic as a result
of athe alert," Riley said. "Those who might have been in contact with
the infected child need to follow through."
Hepatitis A is a viral infection of the liver. Symptoms may include
fatigue, loss of appetite, abdominal discomfort, diarrhea, nausea,
comiting, dark urine, light-colored stolls and jaundice.
Very young children with hepatitis A often have little or no symptoms, a
TDH publication states.
The virus is spread from one person to another in a "hand-to-mouth"
manner. Handwashing, especially after using the restroom and before
handling food, can help prevent the spread of hepatitis A. Once exposed
to the virus, it takes anywhere from two to six weeks to develop the
illness.
Currently, immune globulin is the only readily available form of
intervention to prevent an exposure to HAV fro developing futther. If a
person thinks that they have been exposed, they should talk to their
doctor about getting ID, the publication cautions.
Mike Hathorn, finance officer, presented an estimated 1996 operating
budget of $6.2 million. With capital expenditures of $286,900, the
district would need to collect $1.1 million in property tax revenue to
avoid a deficit.
That could be accomplished with the current 35.5-cent tax rate, Hathorn
said, but it would leave little margin for contingencies.
Board chairman Raul Garcia said the district has not changed the tax
rate since 1992, "which means we have not dealt with inflation. And
devaluation of property hasn't done a thing for us. In the past two or
three years we haven't addressed the need of keeping up with the
effective tax rate."
Elfida Zuniga, Reeves County tax assessor-collector, calculated the
effective tax rate at 39.8234 cents per $100 valuation. That is the rate
that would generate the same amount of operating revenue as the district
assessed last year.
However, because the district also collects sales tax, the highest rate
the district can set without being subject to a rollback election
petition by voters is 37.6618 cents, Zuniga said.
Without the sales tax adjustment of 7.3974 cents, the rollback tax rate
would be 45.0692 cents.
"If the rollback rate is lower than 1.03 times the effective rate, the
unit must publish the notices and hold the hearing to adopt a tax rate
that exceeds the rollback tax rate," Zuniga advised the board in writing.
That left board members confused, and they asked for clarification.
Jeannette Alligood said effective tax rate is more than the rollback
rate. "That doesn't seem reasonable," she said.
Dr. Bang's request for a mammography unit was referred to Carolyn Riley,
chief executive officer, for research to determine the exact cost,
additional staffing and projected revenues for such a purchase.
Riley also asked if the board would like to add $75,000 in incentives
for another family practitioner.
Dr. Kai-wood Ma is expected to open his practice in January, and he
should be generating more income than the hospital has guaranteed by
July 1, she said. That is when a medical school graduate would be
available, and Riley said she has a prospect in mind.
The board agreed to add the $75,000 in incentives with the understanding
it doesn't have to be used.
Hathorn said that a change in management next year when Quorum Health
Resources' contract expires could cause some problems, letting expenses
get out of control and wiping out the estimated cushion.
Some recent changes made in staffing will have an effect for the
remainder of this year, and the carryover could be more than expected,
he said. And he has $200,000 in tax money that has not been used.
"But one payroll will take the biggest part of that. We need to assume
that most of that is going to go away. I said we would have $25,000 left
at the end of the year," he said.
Garcia said that a low census of four patients over the weekend does not
bode well for the revenue side of the projection.
"It doesn't take many days like that to wipe out a 12," Hathorn said.
"Traditionally we have never made our census budget estimates," Alligood
said.
Hathorn estimated an average daily census of 11.39, generating $5.2
million in net patient revenue for 1996. The average census for the
first six months of 1995 was 8.90, generating $2.67 million net revenue.
Included in the proposed budget is a 2.5 percent increase in salary for
employees on their anniversary date except for those at the top of their
pay grade. Hathorn said he included $120,000 for a chief executive
officer and a chief financial officer as hospital employees.
Garcia said the hospital has the best payroll in the county. "Our
salaries are quite high. That is good for our employees. Those are two
things we can't ignore. We have shirked our duties in the past in not
keeping up with inflation in the tax department."
In what may be a first in Texas medical history, more women than men
will be admitted as members of an incoming medical school class at the
University of Texas-Houston Health Science Center.
Dr. M. David Low, president, said that 109 female students in an
incoming class of 200 have been admitted to the university's medical
school.
"For some years now, the national trend has been one of increasing
enrollments of women in medical schools," he said. "I believe, though,
that in Texas medicine our medical school staff and faculty have set the
pace by creating an environment that attracts bright young people
without regard to gender."
"If she knows she's coming here, she will start her license process now
and have her license when she graduates," she said.
The student is from the Philippines and is in New York now competing her
program, Riley said.
Dr. Kai-wood Ma is due to set up practice in January and will be
delivering babies, along with Dr. Joseph Darpolor.
"Dr. Darpolor asked if (the student doctor) could do OB," Riley said.
They are better off if they have three rather than being on OB call
every other night."
Dr. Darpolor is the only physician in Pecos delivering babies at this
time. He is from Africa.
The percentage of minority students admitted in the Houston medical
school's new fall term also held steady at last year's record 25
percent. The minority breakdown shows 36 Mexican-American, 14
African-American and one American Indian enrolled this year.
That means the proposed budget will be on file in the administration
office for public inspection until September 12, when the board will
make any changes they choose, adopt the budget and set the tax rate.
Garcia said that adding the mammogrpahy unit costing $92,000 and another
$75,000 in incentives for a new family practitioner to deliver babies
would force the district to increase taxes.
"If we do this, we probably can't refinance the bonds," said Jeannette
Alligood. "Are we going to be any more financially sound than we have
been?"
Garcia said he looked at the proposed budget and shared it with several
people.
"They agreed. This gentleman (finance officer Mike Hathorn) came up with
a balanced budget," he said. "We came up with additional things, and I
am leery of it."
The board agreed in a workshop Wednesday to add the physician incentive
with hopes of attracting a July medical school graduate. Dr. W.J. Bang
filed a last-minute request for the mammography equipment so he will not
have to send off biopsies during cancer surgery.
Garcia said that Ward County Memorial Hospital will soon have a mobile
mammography unit available and RCH can use it if they come up with their
share of the cost.
That was estimated at $30,000 when the West Texas Coalition was formed
to seek a $300,000 grant for the purchase.
Alligood asked if the board is "going to keep the budget as a dream
sheet instead of a budget to follow."
"We project one thing and come up with another, and we have always come
up short," Garcia said. "This is a conservative budget. This is
something that has to be enforced."
Chel Flores made the motion to file the original proposed budget; Jesse
Prieto seconded and Alligood and Marcella Lovett voted "no." Garcia
broke the tie by voting yes to carry the motion.
"Why were we not allowed to go through this (changed) budget today?"
asked Lovett.
"Because of time," Garcia said.
"I got it 30 minutes before I walked in this morning," Lovett said. "Why
not compare it to the other proposal to be fair to the taxpayers?"
"If the taxpayers have any problem with it, they can come here," Garcia
said.
"We called this meeting to go over it. I would like to go over it,"
Lovett said.
"We can amend the budget (at the Sept. 12 meeting)," Garcia said.
"You know you won't let us do that," Lovett said.
"We have voted to file the original budget. We need to do that today so
we can meet back on September 12," Garcia said, gaveling the noon
meeting closed at 12:30 p.m., 10 minutes after re-convening the workshop
which recessed Wednesday.
Copyright 1996 Pecos Enterprise
324 S. Cedar, Box 2057, Pecos TX 79772
Phone 915-445-5475, FAX 915-445-4321
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