Thursday, May 8, 2008

‘Cash crunch’ at hospital

By Chuck McGuire
Staff Writer

In a Tuesday night meeting that lasted nearly four-and-a-half hours, the Upper San Juan Health Service District Board of Directors made two things abundantly clear. The Pagosa Mountain Hospital (PMH) faces a serious “cash crunch,” and viable solutions include exercising sound judgement in efforts to replace its former CEO.

Based on open discussions between the board, staff, various committee members and the district’s own financial consultant, Ken Johansen, several management missteps apparently resulted in what board secretary Bob Scott has described as “a severe cash crunch” at the hospital. During an April 24 special board meeting, Scott explained his take on the situation and suggested, “everyone throughout the organization needs to focus on getting cash flow into the hospital.”

Tuesday night, in clear support of Scott’s sentiment, Johansen said, “Cash flow projections look good through May and June, but in July, we hit the wall.”

While those involved in Tuesday’s discussion refused to cast blame, comments made during the meeting concerning “leadership” and “the administration” made it obvious that most placed liability for the current financial crisis on former CEO Dan Boatman. A number of administrative delays and revenue-related difficulties came to light, all of which were evidently the CEO’s responsibility. Meanwhile, Boatman, citing personal problems, resigned his position, effective April 28.

As discourse continued, proper coding and billing, the establishment of insurance carrier contracts, a delay in receiving a Medicare Provider number, and delays in applying for Medicaid reimbursement and Critical Access Hospital designation were among the greatest concerns affecting hospital revenue.

As for the coding and subsequent billing of patient medications and services, Boatman had acknowledged difficulty in adequately training personnel to utilize the proper codes. When no, or erroneous, codes are entered into the computer system, billing reflects inaccurate charges, or fails to reflect any at all.

Nevertheless, at an April 18 emergency board meeting, Boatman stated that all claims and billing were current and “out the door,” and not just being held in Dairyland (the hospital computer system). On Wednesday, Johansen suggested Boatman’s assertion was not accurate, and pointed to many “self-pay” and “out-of-network” insurance claims that were never billed.

In the meantime, according to the April 18 meeting minutes, Boatman hired Joy and Brian Sinnott to perform and oversee billing and collections as they have for the district’s ambulance service, for some time. The pair is now working to clean up records and back-bill Medicare claims to April 3.

While acting as CEO, Boatman was charged with negotiating and executing benefits contracts with various insurance providers. Though some work had clearly been done, certain district finance committee members believed it was too little, too late. Because no one seemed sure which contracts, if any, were actually completed, Johansen was asked to determine their exact status.

To do so, he convinced the district to hire Bret Goebel — an Albuquerque consultant specializing in such matters — to contact the various providers and assemble a chart showing which contracts are in effect and which still need work. By Tuesday, Johansen couldn’t say when Goebel would provide answers to district concerns.

From Jan. 7 (opening day), district officials expected hospital revenue to drive cash flow. However, a delay in receiving a Medicare Provider number prevented the hospital from billing for Medicare reimbursement until recently. An apparent delay in responding to a Medicare survey concern caused the delay, and resulted in an approved back-billing date only to April 3. That prohibited the hospital from billing for prior services normally covered by Medicare.

While district officials said they “were led to believe” that an application for Medicaid reimbursement had been completed, it was eventually learned that no such petition had ever been submitted. Therefore, at the April 24 special meeting, Goebel was also put in charge of completing and forwarding that application.

Meanwhile, constant administrative delays slowed the application for Critical Access Hospital designation, which the district has been counting on to secure vital and substantial government reimbursement for all hospital expenses. At this point, according to Joy Sinnott, the government agency responsible for application approval is backlogged with some 600 applications, and processing the application could take up to 150 days. Sinnott thinks final approval may now be six to nine months away.

For now, the district hopes to increase revenue in whatever ways possible. Consequently, Johansen has been given the authority to review outstanding patient invoices and determine a fair and equitable discount for those willing to pay by a certain date.

Because some insurance contracts remain incomplete, many patients have only received “out-of-network” benefits, thus facing higher than expected medical bills. Therefore, any discounts ultimately offered would probably be based on a percentage of what insurance companies would’ve paid for claims from network service providers.

At any rate, should discounts eventually be extended, they would only be valid for a limited time.

As Tuesday’s discussion turned to filling the hospital CEO vacancy, a number of potential options surfaced. Though Johansen and hospital Director of Nursing Linda Mozer are currently addressing finances and handling day-to-day affairs, some board members feel an interim CEO may be beneficial, until a permanent hire is found.

Others expressed interest in allowing Johansen and Mozer to continue the progress they’ve made over the past three weeks, while others feel hiring a management company might be most beneficial. At least two board members suggested hiring a consultant to review and compliment the work Johansen and Mozer are doing, while some insisted that would cause chaos and cost money the district can’t afford to spend.

While a few individual and company names were tossed around, Mercy Regional Medical Center CFO George Sprinkel expressed interest in building a stronger relationship between hospitals, and suggested that Mercy could help with PMH management responsibilities. That sparked enthusiasm among many, including Johansen himself. Sprinkel attended Tuesday’s meeting by invitation from the board.

In the end, the board voted to invite Brad Cochennet, a well-respected Durango-based consultant, to an upcoming long-range planning session and ask what help he may or may not be inclined to offer the district. Meanwhile, Johansen and Mozer will continue their efforts, and the board will pursue more detailed discussions with the Mercy administration.

chuck@pagosasun.com


Lawsuit filed against sheriff, county

By James Robinson
Staff Writer

Archuleta County Sheriff Pete Gonzalez came under fire again Friday with the filing of a lawsuit charging the sheriff with defamation and misdemeanor violations related to elections.

According to Archuleta County Combined Court documents, sheriff’s recall committee chairperson Galen Erin filed suit May 2, naming Gonzalez and Archuleta County Undersheriff John Weiss, in their professional and personal capacities, and Archuleta County as defendants.

Archuleta County Attorney Teresa Williams said the county was served Tuesday with court papers, and has 20 days to respond.

Williams said because Gonzalez and Weiss are county employees, and because Archuleta County was named in the suit, she has forwarded the documents to the county’s insurance company, County Technical Services Inc. whose attorneys will handle the case.

Williams explained that once the attorneys file a response, Erin will set the legal pace for what comes next.

In lieu of attorney, court documents indicate Erin will represent herself in the lawsuit.

Erin declined to comment for this story.

The suit follows in the wake of an effort launched, in part by Erin, April 9 to oust Gonzalez via recall petition and election.

In the suit Erin alleges that “on or about” April 18, the defendants, Gonzalez, Weiss and Archuleta County, engaged in libel and defamation of character by communicating and publishing false statements that were intended to damage Erin’s personal and professional reputation and her reputation as a member of the sheriff’s recall committee.

According to the suit, Erin alleges that Gonzalez’s comments, which appeared in a local online magazine article about the recall effort, have made her appear, “emotionally disturbed, professionally incompetent, intellectually dishonest, unethical and a quack.”

The suit further states that neither Gonzalez or Weiss are “educated, trained, degreed or experienced in the mental health arena, nor do they possess any qualifications to psycho-analyze Plaintiff.”

Erin also alleges that the sheriff’s comments quoted in the article were designed to impede the gathering of petition signatures for the recall effort, hence the allegations of misdemeanor violations related to elections.

In addition to the suit filed against Gonzalez, Erin has leveled other claims against several individuals in the county Road and Bridge Department. For example, in February 2008 (via an e-mail to District Attorney Craig Westberg, a variety of state agencies and area media sources not including The SUN) Erin alleges that an Archuleta County road and bridge operator “intended to physically harm and/or kill” her with the side blade of a motor grader during snow removal operations on her street.

A call was made to Westberg to determine the status of an investigation , if any, into the claim but the district attorney was unavailable for comment by press time.

In other litigious matters, Williams said, despite threats of an impending wrongful termination suit from former sheriff’s department employees Eugene Reilly and Wayne Alexander, the county has not yet been served with court papers related to the claim.

Williams said there is a significant difference between the act of filing a lawsuit with the courts, and actually serving the defendant with papers. According to Williams, the serving of papers triggers subsequent legal proceedings, and without the act, the suit is rendered essentially impotent.

According to Williams, the county received notification via fax April 21, stating if the county did not respond within seven days to Reilly’s and Alexander’s claims, their attorneys would file suit. Williams said a hard copy version of the notification arrived later in the week and was forwarded to CTSI attorneys who will handle the case should the suit move forward.

james@pagosasun.com


Wasley enters DA race

By James Robinson
Staff Writer

It appeared Democrats might go unopposed in their bid for the district attorney’s post in the November election; however, the Republicans have mounted a challenge with Russell Wasley’s entry into the race.

Wasley will face Democratic challenger Todd Risberg.

Wasley currently serves in the 6th Judicial District district attorney’s office as the felony prosecutor for Archuleta County and is a relatively recent arrival to the area. Wasley said he came to La Plata County in October 2007 and began working in the district attorney’s office, first handling misdemeanors before being transferred to felonies and Archuleta County.

Wasley said he graduated from the University of Chicago Law School in 1985, and soon after graduation went to work for the district attorney’s office in Lubbock, Texas, where he served from 1987 to 1991. During his tenure there, Wasley served first as a misdemeanor prosecutor and later became an assistant in the felony division, ultimately managing a docket in the 72nd District Court.

Travis Ware, district attorney in Lubbock County, Texas, described Wasley as a “most tenacious litigator.”

From 1991 to 2004, Wasley handled civil litigation cases for a variety of law firms in Texas and California, but Wasley described the work as “not as rewarding or fulfilling as working in the DA’s office.”

“I returned to prosecution from civil law practice because as a prosecutor, I know that I am on the right side, and I know that every day, I get the opportunity to represent the community and do what is right,” Wasley said.

In 2004, Wasley joined the district attorney’s office in the 9th Judicial District (Glenwood Springs, Meeker) and served as deputy district attorney. Wasley served in the 9th Judicial District until 2007.

Wasley then served a brief stint in the 14th Judicial District before arriving in La Plata County.

In discussing his election bid, Wasley drew a sharp contrast between his approach to prosecution and what he described as Risberg’s “kinder, gentler approach to prosecution.”

“His (Risberg’s) comments created the impression he would bring a weaker and more watered-down approach to prosecution. When I saw he was the only candidate up to that point, I thought that was unacceptable.”

Some have called Risberg’s approach — which calls for viable drug and alcohol courts and juvenile diversion programs and treatment opportunities for first-time offenders— as “progressive prosecution.” Whereas Wasley said he believes in “traditional prosecution” based on deterrence, punishment and rehabilitation.

“The only way to deter bad or dangerous conduct is through aggressive prosecution,” Wasley said. “I believe there is already plenty of plea bargaining going on. The system already gives young, first time offenders a break if they don’t have prior adult felonies. Traditional prosecution already takes into account the age of the offender and priors. It doesn’t make any sense to get any more lenient than that.”

In addition, Wasley said the system already provides many treatment opportunities.

“I don’t believe we should weaken traditional prosecution any further. I believe that the DA is responsible for the safety of the community,” Wasley said.

Wasley said he has prosecuted about 60 criminal trials to verdict, including five homicide trials, and a variety of cases, including those involving sexual assault on adults and children.

“What drives me to seek the office of the district attorney is my belief that behavior that victimizes law abiding citizens must have consequences. Community safety must always be the special concern of the district attorney,” Wasley said.

james@pagosasun.com


NEWS

COUNTY

Commissioners approve three polling places for 2008 elections

By James Robinson

Staff Writer


During the 2008 election season, Archuleta County voters will again cast their ballots in one of three polling places, following commissioner action Tuesday.

With a unanimous vote, the board designated the county commissioners’ meeting room in the Archuleta County Courthouse, the community center on Hot Springs Boulevard and Restoration Fellowship Church on Village Drive as the three polling places for Archuleta County residents.

According to Archuleta County Clerk June Madrid, financial constraints limit the county’s ability to provide federally mandated voting equipment in all eight traditional polling places, thus the use of three vote centers.

Madrid said the vote center location changes from those used in 2006 stemmed from two issues. First, the elections office in the lower level of the courthouse was too small to accommodate voter turnout. Second, Madrid said voter turnout at the Lutheran Church was extremely low.

Madrid said she will continue to use the elections office in the lower level of the courthouse for early voting and mail-in ballots.

james@pagosasun.com


County seeks to register, tax heavy equipment

By James Robinson

Staff Writer

Archuleta County is ramping up efforts to ensure that owners of heavy equipment have properly registered the equipment with the clerk’s office or have listed the equipment on the county tax rolls.
According to Archuleta County Clerk June Madrid, Colorado law requires that owners of heavy equipment (SMM-Special Mobile Equipment) must register or list the equipment although statute provides two exemptions.
First, property owners whose land is classified with the assessor as farming agricultural and whose equipment is used solely on the farm for farming purposes and whose income is derived from farming are exempt from registration in the clerk’s office.

Second, if a property owner keeps the equipment on their property and never moves it off the property, registration with the clerk’s office is not required.
If the equipment is used for business purposes, regardless of whether it is owned or leased, it must be registered in the clerk’s office. If the equipment is moved from job to job, or to another property, registration with the clerk’s office is required.

Madrid said with the building and construction season gearing up, county staff will be on the lookout for unregistered heavy equipment. Once located, Madrid said staff will tag the equipment, notifying the owner to contact the clerk’s office for registration. If registration is not completed, the owner will receive a statement detailing the registration fees. If the registration is not taken care of at that point, the distraint process could begin. If distrained and impounded, there is a $150 impound fee that is collected in addition to the registration fees before the equipment will be released.

For more information on the special mobile machinery tax, contact the clerk’s office at 264-8350.

james@pagosasun.com


New members appointed to airport advisory commission

By James Robinson

Staff Writer

Four new members will join the Archuleta County Airport Advisory Commission, following commissioner action April 15 and May 6.

A split vote April 15 — Archuleta County Commissioners Bob Moomaw and Ronnie Zaday in favor, Archuleta County Commissioner Robin Schiro opposed — placed Michael Arbuthnot, Al Bledsoe, Jim Carey and Kathryn Steen on the commission.

Schiro supported nominating Ralph Goulds over Bledsoe, but because the motion came as an all-or-nothing package, she voted against the nominations.

Carey will finish former commission chair Elmer Schettler’s term which expires in about a year. Schettler resigned in January. Arbuthnot and Steen will serve three-year terms, while Bledsoe would have also served a three-year term. However, Tuesday’s board action changed that.

Following the board’s decision April 15, a review of the commission’s bylaws, particularly a residency requirement clause, indicated there may be an issue with Bledsoe serving.

Although the bylaws do not define “resident,” Moomaw, during the May 6 meeting, said Bledsoe has acknowledged he is not a resident of Archuleta County, thus County Attorney Teresa Williams recommended the board withdraw Bledsoe’s appointment. The board approved Bledsoe’s withdrawal unanimously.

With Bledsoe’s withdrawal complete, the board faced a decision either to appoint Goulds or open the application process again. Schiro moved to appoint Goulds, Moomaw provided a second and Goulds earned a two-to-one vote — Moomaw and Schiro in favor, Zaday opposed.

Zaday has publicly challenged Goulds’ appointment due to his involvement in a 2005 lawsuit regarding hangars and hangar leases at the county airport.

Bledsoe’s appointment marked the second time residency has become an issue for appointees to the Airport Advisory Commission. The first occurred with commission member Mark Weiler, although Weiler registered to vote in Archuleta County, which quelled concerns regarding his residency status.

As part of board action Tuesday, the commissioners directed the Airport Advisory Commission to refine its bylaws such that residency is clearly defined. Once that task is complete, the advisory commission will bring their recommendation before the Board of County Commissioners for their approval.

The Archuleta County Airport Advisory Commission is a group of seven voting members and four non-voting ex-officio members who act in an advisory capacity to the Archuleta County Board of County Commissioners and the Airport Manager.

The commission conducts research, solicits public opinion, assists in planning and otherwise contributes to decisions by the County Commissioners in matters involving the airport.

james@pagosasun.com

TOWN

Wastewater plant project moves along, slowly

By Jim McQuiggin

Staff Wri